• Mohamed A Elsebaey, Mohamed Elsayed Enaba, Heba Elashry, Waleed Elrefaey, Rasha Youssef Hagag, Neveen A Shalaby, Mohamed Sabry Aboelnasr, Mohamed Elsayed Sarhan, Omneya Mohamed Darrag, Assem Mohamed Elsokkary, Mohamed Abd Allah Alabd, Ahmed Mohamed El Nakib, Abdulrashid Onimisi Abdulrahim, Yousry Esam-Eldin Abo-Amer, Mohammad Shaaban Mahfouz, Amina Mahmoud Fouad, Raghda Samir Abd El Latif, Khaled Asem Allam, and Amro Abdelaziz Mohammed Ismail.
• Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt.
• Medicina (Kaunas). 2024 May 19; 60 (5).

AbstractBackground and Objectives: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric twisting without the anatomical constriction of the gastric lumen. During endoscopic examination, the staple line is deviated with a clockwise rotation, and the stenosis requires additional endoscopic manipulations for its transposition. Upper gastrointestinal series show the gastric twist with an upstream dilatation of the gastric tube in some patients. Data on its management have remained scarce. The objective was to assess the efficacy and safety of endoscopic balloon dilatation in the management of functional post-sleeve gastrectomy stenosis. Patients and Methods: Twenty-two patients with functional post-primary-sleeve-gastrectomy stenosis who had an endoscopic balloon dilatation between 2017 and 2023 were included in this retrospective study. Patients with alternative treatment plans and those undergoing endoscopic dilatation for other forms of gastric stenosis were excluded. The clinical outcomes were used to evaluate the efficacy and safety of balloon dilatation in the management of functional gastric stenosis. Results: A total of 45 dilatations were performed with a 30 mm balloon in 22 patients (100%), a 35 mm balloon in 18 patients (81.82%), and a 40 mm balloon in 5 patients (22.73%). The patients' clinical responses after the first balloon dilatation were a complete clinical response (4 patients, 18.18%), a partial clinical response (12 patients, 54.55%), and a non-response (6 patients, 27.27%). Nineteen patients (86.36%) had achieved clinical success at six months. Three patients (13.64%) who remained symptomatic even after achieving the maximal balloon dilation of 40 mm were considered failure of endoscopic dilatation, and they were referred for surgical intervention. No significant adverse events were found during or following the balloon dilatation. Conclusions: Endoscopic balloon dilatation is an effective and safe minimally invasive procedure in the management of functional post-sleeve-gastrectomy stenosis.

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