Management of Strictures in Bariatric Surgery

Stenosis after bariatric surgery is one of the most common complications that can result in significant symptoms such as dysphagia, inability to tolerate solid foods, nausea, vomiting, and reflux. Patients often have difficulty recognizing the symptoms as they are getting used to their new anatomy and limited food intake. Treatment depends on the type of surgery and location of the stenosis. In sleeve gastrectomy patients, the stenosis is often located near the incisura, although proximal strictures may also occur. These are treated with hydrostatic through the scope balloon dilation or pneumatic balloon dilation, with stents reserved for resistant cases. Gastric bypass patients often have anastomotic strictures at the gastrojejunostomy as a result of ischemia and surgical mechanical forces. Endoscopic dilation using through-the-scope dilators remains the mainstay of treatment, although several other techniques have been applied for refractory stenosis. This chapter discusses this complication in various bariatric surgeries and details the importance of understanding the mechanism of the stenosis to better treat the patient in a personalized fashion and address refractory cases.