Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up (with videos)

Background: A large number of patients who undergo laparoscopic sleeve gastrectomy present with surgical complications. Stenosis, in particular, occurs in .7%-4% of cases. Objectives: To report our experience, results, and long-term follow-up after pneumatic dilation of late functional helix stenosis after laparoscopic sleeve gastrectomy. Setting: Multicenter study led by an endoscopic tertiary referral center. Methods: Thirty-five patients were dilated initially at 30 mm. Thirteen out of 35 patients underwent a second dilation up to 35 mm. Only 8 patients underwent a third pneumatic dilation up to 40 mm. The stricture was localized in the mid-body of the sleeve in 32 patients overall; 3 had narrowing adjacent to the cardia. Eleven twists formed an acute angle between the 2 segments of the stomach, whereas 24 angles were obtuse. Seven out of 35 patients presented with persistent dilated pouch above the twist. Two patients were lost to follow-up. Overall outcome at an average follow-up of 15.5 months after primary surgery (range 7-49 mo) was as follows: 12 clinical failures and 1 technical failure (40%) and 60% (20 out of 33) clinical success. Conclusion: Pneumatic dilation of late functional helix stricture is an effective technique for treatment of dysphagia in the majority of patients treated. Complete helix stricture, defined in function of the angle within twist, as well as the presence of a persistently dilated gastric pouch above the kinking, seems to be correlated with higher failure rates.