Endoscopic findings and their clinical correlations in patients with symptoms after gastric bypass surgery

• Published in: Gastrointestinal endoscopy Vol. 58; no. 6; pp. 859 - 866
• Main Authors: Huang, Christopher S, Forse, R.Armour, Jacobson, Brian C, Farraye, Francis A
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2003; Elsevier
• Subjects: Abdominal Pain - etiology; Adult; Biological and medical sciences; Catheterization; Constriction, Pathologic; Endoscopy, Gastrointestinal; Female; Gastric Bypass - adverse effects; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Diseases - diagnosis; Gastrointestinal Diseases - etiology; Humans; Male; Medical sciences; Middle Aged; Postoperative Period; Stomach Ulcer - diagnosis; Human; Stomach; Symptomatology; Correlation; Treatment; Surgery; Gastroenterology; Surgical anastomosis; Endoscopy
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(03)02310-1

The aim of this study was to describe the endoscopic findings in patients with upper GI symptoms after Roux-en-Y gastric bypass surgery and to correlate clinical features with endoscopic findings. Patients with symptoms after Roux-en-Y gastric bypass referred for endoscopy were studied. Endoscopy was performed in standard fashion with a 9.8-mm diameter endoscope. Forty-nine patients underwent a total of 69 upper endoscopy procedures between January 2001 and February 2003. The most common endoscopic findings were the following: normal post-surgical anatomy (21 patients, 43%), marginal ulcer (13 patients, 27%), stomal stenosis (9 patients [19%], including 5 with a concomitant marginal ulcer), and staple-line dehiscence (8 patients [16%], including one with a marginal ulcer). Abdominal pain was the most common symptom (26 patients, 53%) and was more frequent among patients with a normal endoscopy compared with those with an abnormal endoscopy ( p = 0.04). Stomal stenosis was present in 39% of patients with nausea, vomiting, or dysphagia; it was not present in any patient without these symptoms ( p = 0.001). Fifteen percent of procedures performed within the first 6 postoperative months were normal, compared with 53% of those performed beyond 6 months ( p = 0.02). There was no complication of endoscopy. Among patients with symptoms after Roux-en-Y gastric bypass presenting for endoscopy, normal post-surgical anatomy was the most common finding. Marginal ulcer was the most common abnormality. Presentation with abdominal pain and performance of endoscopy beyond the 6th post-operative month were predictive of a normal endoscopy, and lack of nausea, vomiting, and dysphagia predicted the absence of stomal stenosis.