Endoscopic management of gastric stenosis after sleeve gastrectomy: a systematic review and single-arm meta-analysis.

purposeSymptomatic gastric stenosis is a rare but challenging complication following sleeve gastrectomy, leading to malnutrition and a significant reduction in quality of life. With limited data on endoscopic treatments for this issue, this systematic review evaluates the effectiveness and safety of endoscopic interventions for managing gastric stenosis post-sleeve gastrectomy.

methodsPubMed, Cochrane Central, and EMBASE were searched for studies reporting endoscopic management of symptomatic gastric stenosis following sleeve gastrectomy. Case reports or studies involving fewer than five patients, as well as those including patients with concomitant leaks, other types of bariatric procedures, or stenosis of non-gastric origin, were excluded. The outcomes assessed were the number of dilatations or procedures performed, length of hospital stay, clinical response to endoscopic management, use of stents, and the need for subsequent surgery to address symptoms after endoscopic treatment. The proportional meta-analysis was performed with R software.

resultsFrom 1496 initial results, twenty eight studies reporting endoscopic management of symptomatic gastric stenosis following sleeve gastrectomy were included. Our sample comprised 1068 patients. The predominant endoscopic treatments were balloon dilation and stent placement. Most patients experienced a positive endoscopic response (77.8 events per 100 observations; 95% CI 68-85; heterogeneity p-value < 0.01), with an average of 1.82 dilations or endoscopic procedures needed per patient to resolve symptoms (95% CI 1.6-1.9; heterogeneity p-value < 0.01). To achieve symptom resolution, some patients required stent placement (19.2 events per 100 observations; 95% CI 12.9-27.7; Heterogeneity p-value < 0.01). Only a small percentage of patients needed subsequent surgery following endoscopic management (15.9 events per 100 observations; 95% CI 10.6-23.3; Heterogeneity p-value < 0.01).

conclusionOur analysis suggests that endoscopic management of gastric stenosis following sleeve gastrectomy is efficient and safe. The average number of dilatations or procedures required to resolve symptoms is reasonable, as this approach avoids more invasive measures, and the proportion of patients who required subsequent surgical intervention was relatively small. "Level of Evidence: Level III, Systematic Review Study." STUDY REGISTRATION: A review protocol for this systematic review was registered at PROSPERO ID CRD42024594486, October 07, 2024.