Management of post bariatric surgery anastomotic strictures

Gastric bypass remains the leading bariatric procedure performed in the United States, and the number of surgeries performed is increasing dramatically in the face of an intractable obesity epidemic. Although highly effective in the treatment of obesity, the procedure is associated with several significant complications. Anastomotic stricture formation is one of the major postoperative complications encountered by gastroenterologists. Strictures are common, occurring in a significant minority of patients. They generally present with intolerance to oral intake within the first 6 months of surgery. The etiology of stricture formation is not fully know but may be partially related to surgical technique in creating the anastomosis. Endoscopy is an excellent diagnostic test and allows for immediate therapeutic intervention. The strictures are very responsive to endoscopic dilation with either through-the-scope balloons or Savary-Gilliard bougies. Effective dilation is feasible with a low rate of serious complications. Overdilation may negatively impact postoperative weight loss, but in general dilation to less than 15 mm appears to be safe and does not affect postoperative weight loss.