Management of transmesenteric tunnel jejunal strictures with endoscopic dilation by using achalasia balloons (with videos)

Shou jiang Tang, David A. Provost, Edward Livingston, Daniel J. Scott

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Transmesenteric tunnel (TMT) or mesocolic jejunal stricture is an unusual postoperative complication that requires another operation. We hypothesize that endoscopic dilation by using achalasia dilatation balloons can be used to treat some TMT jejunal strictures. Patients: This study involved 6 consecutive cases of TMT stricture. Intervention: The TMT strictures were dilated by using achalasia balloons (30-40 mm) under fluoroscopic and endoscopic guidance. Results: With endotherapy, 4 patients with late onset of symptoms (>3 weeks after Roux-en-Y gastric bypass) have not required another operation to date, with a follow-up of at least 5 to 12 months. Two patients with early onset of symptoms (<3 weeks after surgery) required operations, and 1 of these patients (symptoms onset <7 days after surgery) developed jejunal perforation within the stricture during dilation due to underlying jejunal ischemia within the stricture. Limitations: Small case number and limited follow-up period. Conclusion: Endoscopic dilation by using achalasia balloons can be used to treat some TMT jejunal strictures without another operation. Surgery should be considered in patients with early onset of obstructive symptoms and/or with jejunal ischemia within the stricture.

Original languageEnglish (US)
Pages (from-to)154-158
Number of pages5
JournalGastrointestinal endoscopy
Volume70
Issue number1
DOIs
StatePublished - Jul 1 2009

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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