Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10371-10379
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10371
Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention
Anand Nath, Sayali Yewale, Tung Tran, John S Brebbia, Timothy R Shope, Timothy R Koch
Anand Nath, Department of Medicine, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
Sayali Yewale, Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ 07740, United States
Tung Tran, John S Brebbia, Timothy R Shope, Timothy R Koch, Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
Author contributions: Nath A and Yewale S participated in literature review, in collection of clinical and experimental data for this study, and in writing the manuscript; Tran T performed the statistical analysis; Brebbia JS, Shope TR and Koch TR conceived of and designed this study, and reviewed, edited, and finalized the manuscript; all authors read and approved the final paper.
Institutional review board statement: This study was reviewed and approved by the Human Studies Subcommittee of the MedStar Research Institute, Hyattsville, MD, United States.
Informed consent statement: The Human Studies Subcommittee of the MedStar Research Institute, Hyattsville, MD did not require informed and written consent for this retrospective study.
Conflict-of-interest statement: All of the authors have no conflict of interest to report regarding the publication of this paper.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at timothy.r.koch@medstar.net.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Timothy R Koch, MD, Professor of Medicine (Gastroenterology), Center for Advanced Laparoscopic General and Bariatric Surgery, POB South Tower, Suite 301, 106 Irving Street, NW, Washington, DC 20010, United States. timothy.r.koch@medstar.net
Telephone: +1-202-8777788 Fax: +1-877-6808198
Received: August 28, 2016
Peer-review started: September 1, 2016
First decision: September 12, 2016
Revised: October 9, 2016
Accepted: November 28, 2016
Article in press: November 28, 2016
Published online: December 21, 2016
Processing time: 113 Days and 10.4 Hours
Abstract
AIM

To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG).

METHODS

VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage.

RESULTS

Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids.

CONCLUSION

Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

Keywords: Obesity; Bariatric surgery; Vertical sleeve gastrectomy; Dysphagia; Stomach dilatation

Core tip: Vertical sleeve gastrectomy (VSG) is rapidly becoming the most commonly performed bariatric surgical procedure. Post-operative dysphagia is present in 22.7% of patients after VSG. Medical conditions significantly associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. After VSG, 9.3% of patients develop narrowing of the gastric sleeve. In patients with dysphagia after sleeve gastrectomy and evidence for narrowing of the gastric sleeve, hydrostatic balloon dilatations of the gastric sleeve leads to resolution of dysphagia in 69% of patients.