A 55-year-old female patient with prior sleeve gastrectomy and subsequent Roux-en-Y gastric bypass conversion presented with progressive dysphagia. Several years prior, a self-expanding metal stent had been placed to manage postbariatric dysphagia. The patient subsequently developed a proximal esophageal B-ring with critical luminal narrowing at the superior margin of the stent. This complication is described in the literature but may be underrecognized in postbariatric patients. Two esophageal balloon dilations provided only temporary relief before stricture recurrence. The clinical course was complicated by upper gastrointestinal bleeding, progressive anemia, and severe malnutrition requiring prolonged total parenteral nutrition. Given the failure of nonoperative interventions, the patient underwent exploratory laparotomy with surgical jejunostomy placement. At the two-week follow-up, the patient tolerated tube feeds and demonstrated early nutritional recovery. The mechanism is hypothesized to involve fibrosis from chronic mechanical irritation at the stent margin, potentially accelerated in postbariatric patients due to nutritional deficiencies and altered esophageal physiology. Clinicians should be aware that new stricture formation has been reported following benign esophageal stent placement. Close endoscopic surveillance of the proximal stent margin may permit early detection of reactive tissue changes in this population.
Tanyous et al. (Fri,) studied this question.