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CC BY 4.0 · Endosc Int Open 2025; 13: a27433189
DOI: 10.1055/a-2743-3189
Original article

Endoscopic stricturotomy for axis-related gastric outlet obstruction following sleeve gastrectomy

Authors

  • Luana Gabriela dos Santos 

    1   Graduação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Ringgold ID: RIN117265)

  • Miriam Chinzon 

    2   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirao Preto, Brazil

  • Alexandre Moraes Bestetti 

    2   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirao Preto, Brazil

  • Diogo Turiani Hourneaux de Moura 

    2   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirao Preto, Brazil

  • Eduardo Guimarães Hourneaux de Moura 

    2   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirao Preto, Brazil
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Abstract

Background and study aims

Axis deviation and helical stricture following sleeve gastrectomy may result in functional gastric outlet obstruction, leading to significant patient morbidity. Conventional endoscopic therapies, such as balloon dilation and self-expandable metal stents (SEMS), have demonstrated limited efficacy and are frequently associated with recurrence and complications. This study aimed to assess clinical outcomes of endoscopic stricturotomy as a minimally invasive technique for managing axis-related stenosis after sleeve gastrectomy.

Patients and methods

This retrospective case series included adult patients (≥ 18 years) who underwent endoscopic stricturotomy for axis-related stenosis at a tertiary academic center from 2019 to 2024. Diagnosis of helical stricture was confirmed via endoscopic and radiologic assessments. Clinical data were obtained through electronic chart review and structured telephone interviews. Symptom severity was evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using a visual analog scale (VAS). Statistical analysis included the Shapiro-Wilk test and paired t-test or Wilcoxon signed-rank test, with P < 0.05 considered significant.

Results

Eight patients (mean age 53 years; 62.5% female) were included, with a mean time of 31.3 months between surgery and stricturotomy. All GCSI domains showed significant symptom improvement. The global GCSI score improved from 35.44 to 21.66 (P = 0.014), and VAS scores increased from 3.0 to 7.75. Complications included two cases of intraoperative pneumoperitoneum and one delayed gastric fistula, all managed non-surgically.

Conclusions

Endoscopic stricturotomy is a promising, minimally invasive treatment for axis-related gastric outlet obstruction post-sleeve gastrectomy. Prospective studies are warranted to confirm long-term outcomes.

Keywords

Endoscopy Upper GI Tract - Dilation, injection, stenting - POEM - Endoscopic resection (ESD, EMRc, ...)

Supplementary Material



Publication History

Received: 17 July 2025

Accepted after revision: 24 October 2025

Accepted Manuscript online:
10 November 2025

Article published online:
03 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Luana Gabriela dos Santos, Miriam Chinzon, Alexandre Moraes Bestetti, Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura. Endoscopic stricturotomy for axis-related gastric outlet obstruction following sleeve gastrectomy. Endosc Int Open 2025; 13: a27433189.
DOI: 10.1055/a-2743-3189
 

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