Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis Salman Al Sabah 1 • Eliana Al Haddad 1 Received: 9 August 2016 / Accepted: 7 December 2016 Ó Springer Science+Business Media New York 2016 Abstract Introduction Laparoscopic sleeve gastrectomy (LSG) is becoming an increasingly popular form of bariatric sur- gery, accounting for more than 50% of these procedures performed in the USA. Given this popularity, more is being understood about the complications associated with LSG, which, though uncommon, include the formation of stric- tures and stenosis. The purpose of this study is to establish a safe and effective protocol for the treatment of stenosis post-LSG using endoscopic balloon dilatation. Materials and methods This is a prospective review of 26 patients who had undergone LSG in Kuwait, followed by sleeve gastrectomy stenosis (SGS) and were then referred to Amiri Hospital for endoscopic balloon dilatation from October 2008 up to June 2016. Results A total of 26 patients (four males; 22 females) presented with symptoms of stenosis post-LSG during the study period. The mean age of the patients was 34.6 ± 10.8 years. The mean body mass index at the time of surgery was 43 ± 1.6 kg/m 2 . The median interval from the initial LSG surgery was 95 days. Nine patients had an early presentation (B3 months from surgery), while 17 presented late ( [ 3 months). The patients were followed for a mean duration of 156 ± 20 days from the last endoscopic balloon dilatation. A total of 23 (88.5%) patients had complete resolution of their symptoms. Adverse events were observed in one patients, who was removed from the study. Conclusions Gastric stenosis is a rare but potentially serious complication of LSG. Serial dilatation of SGS employing endoscopic balloons is a safe method of treat- ment, with high efficacy rates. This new method may offer a less invasive alternative to surgical revision. However, if endoscopic treatment fails, surgery is necessary. Keywords Laparoscopic sleeve gastrectomy Á Stenosis Á Strictures Á Endoscopy Á Dilatation Á Obesity Á Kuwait Obesity is a global epidemic, with a significant documented morbidity and mortality. The prevalence of obesity is continuously rising worldwide: increasing from 29 to 37% in men and from 30 to 38% in women from 1980 until 2013 [1]. In Kuwait, 80.4% of the population is overweight, with 47.5% classified as obese [2]. While conventional methods for weight loss have proven efficacious for a certain pop- ulation of people, bariatric surgery has been shown to produce the most predictable and tangible results for a certain subset of patients who qualify. Most weight loss surgeries today are performed using minimally invasive techniques. The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band and biliopancreatic diversion with duodenal switch. A study performed by Cleveland Clinic in 2015 showed that sleeve gastrectomy (SG) has become the most popular method of weight loss surgery in the USA, accounting for nearly 52% of all weight loss operations, surpassing laparoscopic gastric bypass, which had been the most common procedure for decades [3]. Even though laparoscopic sleeve gastrectomy (LSG) is considered a safe and effective option for the management of morbid obesity, owing to the increase in the number of this procedure, surgeons now have a better understanding of the & Salman Al Sabah salman.k.alsabah@gmail.com Eliana Al Haddad eliana.h91@gmail.com 1 Al Amiri Hospital, Kuwait City, Kuwait 123 Surg Endosc DOI 10.1007/s00464-016-5385-9 and Other Interventional Techniques