The hidden endoscopic burden of Roux-en-Y gastric bypass surgery

Background and aims: Complication rates of Roux-en-Y gastric bypass (RYGB) vary from centre to centre, but anastomotic stricture is the commonest, and is managed in the majority by endoscopic pneumatic dilatation. The aim of this study was to assess the endoscopic burden of RYGB surgery.

Patients and methods: All patients undergoing RYGB surgery over a 29-month period were included and were followed-up retrospectively and prospectively for a minimum of 180 days to monitor for endoscopic procedures performed in relation to the RYGB at Walsall Manor Hospital, UK. Five hundred and fifty-three patients underwent RYGB surgery during the study period.

Results: One hundred and thirteen patients had 147 endoscopic procedures, including 65 pneumatic dilatations, at a cost to the NHS of £58 077 over a 29-month study period, with an average cost of £2003 a month. or £105 per RYGB operation performed. The anastomotic stricture rate for the group was 11.39%. The complication rate for dilatation of anastomotic strictures was 0%.

Conclusions: RYGB anastomotic strictures can be safely managed by dilatation. If bariatric surgery is performed locally, then endoscopy departments must expect to factor in, not only the burden of dealing with actual complications, but also the burden of investigating for potential complications.