Endoscopic dilation of gastroesophageal anastomosis stricture after gastric bypass.

BACKGROUND: The management of strictures after gastric bypass procedure using balloon dilation is described. METHODS: A retrospective review of all dilations performed is presented. Balloon dilators were used, and all strictures were dilated initially up to 12 to 15 mm for 1 min. RESULTS: The review included 24 patients with a mean age of 42.8 years and a mean body mass index of 49.6. All the patients except one were women. In terms of procedure, 67% required one dilation and 30% required two. In the first 3 months after surgery, 21 patients developed the stricture. Three patients (13%) had leaks. There was no endoscopic appearance suggesting the need for a repeated procedure. All the dilations were successful, and weight loss compared well with that in the rest of the patients. CONCLUSIONS: A successful technique for the treatment of anastomotic strictures after gastric bypass is presented. Most of the patients required one dilation. Most strictures appeared during the first 3 months after surgery. Female gender and leak may be high risk factors for the development of stricture.

Long-term stenting for choledocholithiasis.

Endoscopic biliary sphincterotomy and stone removal has become the standard of care for choledocholithiasis. Surgical intervention has been undertaken when stones cannot be removed endoscopically. In such patients who are high risk surgical candidates, an alternative therapy is the endoscopic placement of long-term plastic stents to allow biliary decompression. Though such stents usually occlude by three months, they may act as a wick to allow drainage of bile into the duodenum. This case report describes a patient with choledocholithiasis who was treated for 19 months with a biliary stent before expiring from unrelated causes.

Pulmonary function changes after large volume paracentesis.

Large volume paracentesis (LVP) is a safe, rapid, and effective treatment of ascites in cirrhotic patients. We investigated the effects of a 5-L aspiration of ascites on pulmonary function parameters in eight hemodynamically stable patients with cirrhosis and tense ascites. None had known lung disease or abnormal chest roentgenograms. At baseline, mean lung volumes, diffusing capacity, and arterial pO2 were all reduced from normal predicted values. Airflow, however, when related to lung volume, was normal. Post-LVP, lung volumes increased significantly; the mean expiratory reserve volume showed the greatest percent increase (105%) and correlated with the increases in the vital capacity, functional residual capacity, and total lung capacity. Airflow, the mean diffusing capacity, and arterial oxygenation were not significantly changed after LVP. We conclude that LVP significantly increases indices of lung volume but does not significantly alter parameters of airflow or gas exchange.