Fluoroscopic parameters in the diagnosis and quantitative assessment of gastric sleeve stenosis

Abstract Background The diagnosis of gastric sleeve stenosis (GSS) is often delayed due to the lack of readily available objective criteria. The aim of this study was to assess whether fluoroscopic parameters obtained during endoscopy may offer a widely available method to assess GSS. Methods This was a retrospective analysis of a single-institution, prospective database of patients who underwent endoscopic evaluation of suspected GSS. Endoscopic severity of GSS, defined by the presence of stenosis and angulation at the level of the incisura, was systemically assessed by a trained bariatric endoscopist. The width of the incisura and angle between the proximal and distal sleeve were measured fluoroscopically. Balloon diameter measurements were obtained at different balloon volumes during impedance planimetry testing and correlated with incisura width. Results A total of 63 procedures were included. When stratified by endoscopic impression of stenosis, the mean (± standard deviation) width of the incisura in patients with no stenosis was 17.1 ± 6.5 mm, mild stenosis was 13.1 ± 5.1 mm, moderate stenosis was 12.4 ± 2.6 mm, and severe stenosis was 8.6 ± 2.1 mm ( p < 0.001). When stratified by endoscopic impression of angulation, the mean (± standard deviation) width of patients with no angulation was 101 ± 29 degrees, mild angulation was 80 ± 28 degrees, moderate angulation was 76 ± 22 degrees, and severe angulation was 68 ± 20 degrees ( p = 0.21). The width of the incisura correlated with balloon diameter on impedance planimetry (all p < 0.05). Conclusions Fluoroscopic analysis in GSS supports endoscopic impressions of stenosis severity and complements impedance planimetry measurements. This approach offers a more widely available method for diagnosis of GSS.