How to manage sleeve complications through endoscopy: Strictures

Proper understanding of laparoscopic sleeve gastrectomy complications, including sleeve stenosis, remains pivotal for the bariatric surgeon and practicing gastroenterologist. In this chapter, we will highlight the baseline knowledge and the rate of stricture formation after sleeve gastrectomy. Additionally, we review the mechanisms of stricture formation as well as the most common location within the gastric sleeve. Finally, this review provides and in-depth discussion of currently available endoscopic treatments for sleeve stenosis. At present, balloon dilation remains the preferred strategy for treatment of sleeve-associated strictures; however, stenosis length and location may suggest preference for which type of balloon should be utilized. Other endoscopic strategies that are also reviewed include placement of a self-expanding metal stent (SEMS) or more novel techniques such as endoscopic tunneled stricturotomy or gastric peroral endoscopic myotomy (G-POEM). Ultimately, an individualized treatment approach should be undertaken to ensure successful dilation and lasting results.