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Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass.
Surg Obes Relat Dis. 2010 Sep-Oct; 6(5):526-31.SO

Abstract

BACKGROUND

Common endoscopic findings in patients who have undergone Roux-en-Y gastric bypass (RYGB) with chronic abdominal pain have included marginal ulceration, gastrogastric fistula, and jejunal erosion. However, suture or staples eroding into the gastric pouch can also contribute to abdominal pain. Redundant suture is typically regarded as a normal part of the postoperative anatomy. The objectives of the present study were to assess the effects of endoscopic foreign body removal of partially exposed sutures and staples in post-RYGB patients with chronic abdominal pain at a university hospital in the United States.

METHODS

We performed a retrospective study of consecutive patients from January 2006 to July 2007. Post-RYGB patients with chronic abdominal pain underwent endoscopic foreign body removal of exposed sutures/staples. Pain scores were obtained before the procedure, immediately after the procedure, and at the telephone follow-up (median 7.2 months).

RESULTS

Of 21 patients, 15 (71%) reported immediate symptomatic improvement. Specific endoscopic accessories were found to be more useful than others in managing the various foreign materials. Of the 21 patients, 15 (71%) were available for telephone follow-up. Of these 15 patients, 13 (87%) reported continued symptomatic improvement, with 9 (60%) reporting complete pain resolution and 4 (27%) reporting partial improvement. Eroded foreign material was seen in association with marginal ulcers in 3 patients (14%), gastritis in 7 patients (33%), and an inflammatory polyp in 1 patient (5%).

CONCLUSIONS

Eroded suture and staples can cause chronic abdominal pain in post-RYGB patients. In symptomatic patients, visible suture or staples should be considered a potential etiology of chronic pain, instead of normal postoperative findings. Endoscopic foreign body removal might be of therapeutic benefit in these patients.

Authors+Show Affiliations

Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20870185

Citation

Ryou, Marvin, et al. "Endoscopic Foreign Body Removal for Treatment of Chronic Abdominal Pain in Patients After Roux-en-Y Gastric Bypass." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 6, no. 5, 2010, pp. 526-31.
Ryou M, Mogabgab O, Lautz DB, et al. Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(5):526-31.
Ryou, M., Mogabgab, O., Lautz, D. B., & Thompson, C. C. (2010). Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 6(5), 526-31. https://doi.org/10.1016/j.soard.2010.02.035
Ryou M, et al. Endoscopic Foreign Body Removal for Treatment of Chronic Abdominal Pain in Patients After Roux-en-Y Gastric Bypass. Surg Obes Relat Dis. 2010 Sep-Oct;6(5):526-31. PubMed PMID: 20870185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass. AU - Ryou,Marvin, AU - Mogabgab,Owen, AU - Lautz,David B, AU - Thompson,Christopher C, Y1 - 2010/02/19/ PY - 2009/08/12/received PY - 2010/02/02/revised PY - 2010/02/05/accepted PY - 2010/9/28/entrez PY - 2010/9/28/pubmed PY - 2011/2/5/medline SP - 526 EP - 31 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 6 IS - 5 N2 - BACKGROUND: Common endoscopic findings in patients who have undergone Roux-en-Y gastric bypass (RYGB) with chronic abdominal pain have included marginal ulceration, gastrogastric fistula, and jejunal erosion. However, suture or staples eroding into the gastric pouch can also contribute to abdominal pain. Redundant suture is typically regarded as a normal part of the postoperative anatomy. The objectives of the present study were to assess the effects of endoscopic foreign body removal of partially exposed sutures and staples in post-RYGB patients with chronic abdominal pain at a university hospital in the United States. METHODS: We performed a retrospective study of consecutive patients from January 2006 to July 2007. Post-RYGB patients with chronic abdominal pain underwent endoscopic foreign body removal of exposed sutures/staples. Pain scores were obtained before the procedure, immediately after the procedure, and at the telephone follow-up (median 7.2 months). RESULTS: Of 21 patients, 15 (71%) reported immediate symptomatic improvement. Specific endoscopic accessories were found to be more useful than others in managing the various foreign materials. Of the 21 patients, 15 (71%) were available for telephone follow-up. Of these 15 patients, 13 (87%) reported continued symptomatic improvement, with 9 (60%) reporting complete pain resolution and 4 (27%) reporting partial improvement. Eroded foreign material was seen in association with marginal ulcers in 3 patients (14%), gastritis in 7 patients (33%), and an inflammatory polyp in 1 patient (5%). CONCLUSIONS: Eroded suture and staples can cause chronic abdominal pain in post-RYGB patients. In symptomatic patients, visible suture or staples should be considered a potential etiology of chronic pain, instead of normal postoperative findings. Endoscopic foreign body removal might be of therapeutic benefit in these patients. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/20870185/Endoscopic_foreign_body_removal_for_treatment_of_chronic_abdominal_pain_in_patients_after_Roux_en_Y_gastric_bypass_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(10)00075-4 DB - PRIME DP - Unbound Medicine ER -