Abstract
Background and study aims
Axis deviation and helical stricture following sleeve gastrectomy may result in functional
gastric outlet obstruction, leading to significant patient morbidity. Conventional
endoscopic therapies, such as balloon dilation and self-expandable metal stents (SEMS),
have demonstrated limited efficacy and are frequently associated with recurrence and
complications. This study aimed to assess clinical outcomes of endoscopic stricturotomy
as a minimally invasive technique for managing axis-related stenosis after sleeve
gastrectomy.
Patients and methods
This retrospective case series included adult patients (≥ 18 years) who underwent
endoscopic stricturotomy for axis-related stenosis at a tertiary academic center from
2019 to 2024. Diagnosis of helical stricture was confirmed via endoscopic and radiologic
assessments. Clinical data were obtained through electronic chart review and structured
telephone interviews. Symptom severity was evaluated using the Gastroparesis Cardinal
Symptom Index (GCSI), and quality of life was assessed using a visual analog scale
(VAS). Statistical analysis included the Shapiro-Wilk test and paired t-test or Wilcoxon
signed-rank test, with P < 0.05 considered significant.
Results
Eight patients (mean age 53 years; 62.5% female) were included, with a mean time of
31.3 months between surgery and stricturotomy. All GCSI domains showed significant
symptom improvement. The global GCSI score improved from 35.44 to 21.66 (P = 0.014), and VAS scores increased from 3.0 to 7.75. Complications included two cases
of intraoperative pneumoperitoneum and one delayed gastric fistula, all managed non-surgically.
Conclusions
Endoscopic stricturotomy is a promising, minimally invasive treatment for axis-related
gastric outlet obstruction post-sleeve gastrectomy. Prospective studies are warranted
to confirm long-term outcomes.
Keywords
Endoscopy Upper GI Tract - Dilation, injection, stenting - POEM - Endoscopic resection
(ESD, EMRc, ...)
Bibliographical Record
Luana Gabriela dos Santos, Miriam Chinzon, Alexandre Moraes Bestetti, Diogo Turiani
Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura. Endoscopic stricturotomy
for axis-related gastric outlet obstruction following sleeve gastrectomy. Endosc Int
Open 2025; 13: a27433189.
DOI: 10.1055/a-2743-3189
