Modified gastric peroral endoscopic myotomy for helical stenosis after sleeve gastrectomy

Background and Aims: Gastric sleeve stenosis (GSS) occurs in 0.7% to 4% of cases after laparoscopic sleeve gastrectomy and can lead to leaks, fistulas, refractory reflux, regurgitation, and diet intolerance. It is classified into 2 subtypes: helical and nonhelical. Although stent placement and pneumatic dilation may help with nonhelical stenosis, they often do not produce sufficient results for helical stenosis. Recently, a modified gastric peroral endoscopic myotomy (G-POEM) technique (tunneling stricturotomy) has been introduced as a salvage treatment for GSS. Methods: In this case series, we present 3 cases of patients with helical sleeve stenosis treated with modified G-POEM as the initial approach. All patients in this series underwent under-saline solution tunneling, which helped navigate a swirling, challenging submucosal space. The article offers techniques and tips for successfully completing the procedure. Results: The procedure was successfully performed in all patients, who experienced significant clinical improvement and were able to tolerate a low-residue diet. No adverse events were reported. Conclusions: Although our case series demonstrates that tunneling stricturotomy was safe and effective as a primary treatment for gastric sleeve helical stenosis, additional data are needed to evaluate its safety and long-term effectiveness compared with other endoscopic treatments.