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Anastomotic Stenosis (Stricture) After Gastric Bypass Surgery

What is stenosis after gastric bypass surgery?

After gastric bypass surgery for weight loss, the new connection between the stomach pouch and the small intestine may narrow. This is called an anastomotic stenosis. It’s also known as a stricture.

What causes stenosis after gastric bypass surgery?

It's not clear why stenosis occurs after gastric bypass surgery. It may be because of a combination of factors. Stenosis may be caused by:

  • Use of staples, especially circular staples, rather than stitches (sutures)
  • Scarring
  • Not enough blood flow to the area
  • Sores (ulcers) at the anastomosis caused by smoking or taking aspirin or anti-inflammatory nonsteroidal medicines (NSAIDs) too often

Who is at risk for stenosis after gastric bypass surgery?

People are most at risk for stenosis 3 to 4 weeks after gastric bypass surgery. It can occur later on, but then it’s often in addition to other problems, such as sores (ulcers) at the anastomosis. If you smoke or take aspirin or NSAIDs, you are at risk for stenosis, even a long time after you had surgery.

What are the symptoms of stenosis after gastric bypass surgery?

The symptoms of stenosis can include:

  • Nausea
  • Vomiting of undigested food, especially right after eating
  • Trouble swallowing
  • Feeling of fullness in the upper middle abdomen after eating, that lasts a long time
  • Trouble eating certain foods

How is stenosis after gastric bypass surgery diagnosed?

Your healthcare provider will assess your symptoms and give you a physical exam. You may have a test called an upper GI. This can show if there is a stricture. Or you may have an upper endoscopy so your doctor can look at the area.

How is stenosis after gastric bypass surgery treated?

During an upper endoscopy, your doctor will inflate a special balloon at the anastomosis. The opening will be stretched back to its original size, if possible. This is called endoscopic dilation. In some cases, you may need more surgery to fix problems related to stenosis. You may also need to take proton pump inhibitor medicine to reduce your stomach acid.

Can stenosis after gastric bypass surgery be prevented?

To help prevent stenosis, follow your healthcare provider's instructions about when and what to eat after gastric bypass surgery. Talk with your healthcare provider about your use of aspirin or nonsteroidal anti-inflammatory medicines (NSAIDS). And make sure to not smoke. If you need help quitting, talk with your healthcare provider.

Key points

  • After gastric bypass surgery for weight loss, the new connection between the stomach pouch and the small intestine may narrow. This is called an anastomotic stenosis.
  • It's not clear why stenosis occurs after gastric bypass surgery.
  • Smoking and taking nonsteroidal anti-inflammatory medicines (NSAIDS) can make it more likely for you to develop stenosis.
  • The simplest way to fix stenosis is with a procedure called endoscopic dilation.
  • To help prevent stenosis, follow your healthcare provider’s advice on when and what to eat.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Medical Reviewers:

  • Brown, Kim, APRN
  • Meilahn, John, MD