Bariatric surgery is the most effective treatment to achieve weight loss and to improve metabolic outcomes. In this context, Roux-en-Y gastric bypass (RYGB), is one of the main surgical procedures for obesity. Although it is effective, it is burdened by early and late complications such as gastro-jejunal (GJ) anastomotic stricture. In this context, endoscopic balloon dilation is an effective non-operative approach. Aim of our meta-analysis is to evaluate clinical success and safety of endoscopic balloon dilation.

This MA was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. A systematic literature search of MEDLINE, SCOPUS and EMBASE databases was performed. For clinical success, the DerSimonian and Laird random-effects model estimated the untransformed proportions. This approach provides a point estimate from the analysis along with 95% Confidence Interval (95% C.I.) from the rate proportion of the estimate. For all other analyses, a p value less than .05 was considered statistically significant.We included 26 studies.

In 26 studies, the overall clinical success rate was 98.3% (95% CI: 97.08-99.61%) with no significant difference between patients undergoing open and laparoscopic surgery. The presence of anastomotic ulcers was significantly associated with reduced clinical success, with a negative correlation (estimate = 0.0021, p < 0.0001), suggesting that the presence of anastomotic ulcers negatively impacts the clinical success. Among the 24 studies, the improvement rate after a single session was 54.13% (95% CI: 44.09–64.17%). A significant inverse correlation between the presence of anastomotic ulcers and symptom improvement after one dilation session, confirming that ulcer on anastomotic stricture may require more than one dilation session (p=0.007). Overall the pooled rate of adverse (EAs) was 0.72% (95%. CI: 0.12-1.33% I²= 0%). Most of EAs are bleeding, perforation or mucosal tears managed conservatively with no needed of surgery. No significant difference on safety was observed between patients undergone laparotomy (p=0.53) compared to those undergone laparoscopic surgery (p=0.40). Furthermore, no association with stapler type (p=0.34), time to diagnosis/treatment (p=0.71) and presence of anastomotic ulcer (p=0.49)was observed.

Endoscopic balloon dilation is a highly effective and safe treatment for GJ anastomotic strictures following Roux-en-Y gastric bypass. Altough patients with ulcer-associated strictures may need multiple dilation sessions, the overall clinical success remain excellent.