S2196 How Many Dilations Are Too Many? A Meta-Analysis of Endoscopic Balloon Dilation Outcomes and Surgical Conversion in Gastric Sleeve Stenosis

Introduction: Gastric sleeve stenosis (GSS) is a recognized complication following laparoscopic sleeve gastrectomy (LSG), often resulting in nausea, vomiting, and oral intolerance. Endoscopic balloon dilation (EBD) is the first-line therapeutic option, yet the number of sessions required for symptom resolution and the threshold for considering surgical conversion remain unclear. We performed a systematic review and meta-analysis that evaluates the efficacy of EBD, and the rates of escalation to stenting or Roux-en-Y gastric bypass (RYGB). Methods: We performed a systematic review of PubMed, Ovid, Cochrane and Google Scholar to identify studies reporting EBD in adult patients with GSS post-LSG. Primary outcomes were clinical success, mean number of dilations, recurrence, and need for further interventions such as endoscopic stenting or RYGB. Pooled outcomes were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Twenty-six studies comprising 948 patients (83.5% women) were included. The pooled clinical success rate of EBD was 81.6% (95% CI: 72.93–88.92), with a mean of 1.78 dilation sessions (95% CI: 1.63–1.92) required for resolution. Despite initial success, recurrence/restenosis occurred in 21.97%. 17.52% required reintervention with a different modality which included stent placement (8.93%; success rate: 67.08%) or RYGB (10.79%, success rate: 100%). Adverse events were rare at a pooled rate of 5.6%, including perforation (0.53%) and life-threatening bleeding (0.24%). Conclusion: Most patients with GSS respond to one or 2 EBD sessions, with diminishing returns from additional dilations. Recurrence and reintervention remain common, suggesting that persistent symptoms beyond 2 dilation attempts may warrant early consideration of stenting or surgical conversion. These findings offer a practical framework for when to escalate therapy in the management of post-LSG sleeve stenosis.