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Gastric sleeve stenosis (GSS) is described in 1%–4% of patients. To evaluate the role of endoscopy in the management of stenosis after laparoscopic sleeve gastrectomy using a standardized approach according to the characteristic of stenosis. Retrospective, observational, single-center study on patients referred from several bariatric surgery departments to an endoscopic referral center. We enrolled 202 patients. All patients underwent endoscopy in a fluoroscopy setting, and a systematic classification of the type, site, and length of the GSS was performed. According to the characteristics of the stenosis, patients underwent pneumatic dilatation or placement of a self-expandable metal stent or a lumen-apposed metal stent. Failure of endoscopic treatment was considered an indication for redo surgery, whereas patients with partial or complete response were followed up for 2 years. In the event of a recurrence, a different endoscopic approach was used. We found inflammatory strictures in 4.5% of patients, pure narrowing in 11%, and functional stenosis in 84.5%. Stenosis was in the upper tract of the stomach in 53 patients, whereas medium and distal stenosis was detected in 138 and 11 patients, respectively, and short stenosis in 194 patients. A total of 126 patients underwent pneumatic dilatation, 8 self-expandable metal stent placement, 64 lumen-apposed metal stent positioning, and 36 combined therapy. The overall rate of endoscopy success was 69%. GSS should be considered to be a chronic disease, and the endoscopic approach seems to be the most successful treatment, with a prolonged positive outcome of 69%. Characteristics of the stenosis should guide the most suitable endoscopic approach. [ABSTRACT FROM AUTHOR]

Résumé: Les manifestations extra-intestinales des maladies inflammatoires chroniques de l'intestin (MICI) sont fréquentes et polymorphes, dominées par les atteintes ostéoarticulaires et cutanéo-muqueuses. Ces manifestations ont un impact significatif sur la qualité de vie des patients et sur les choix thérapeutiques du clinicien. Les manifestations extra-intestinales associées aux MICI surviennent de façon plus fréquente au cours de la maladie de Crohn par rapport à la rectocolite hémorragique. La plupart des manifestations extradigestives évoluent de façon synchrone avec l'activité de la MICI. Un certain nombre peut néanmoins évoluer de façon dissociée, nécessitant des prises en charge concomitantes. Cette distinction souligne la physiopathologie complexe de ces manifestations qui peuvent faire intervenir d'un côté le déclenchement d'une réponse immunitaire au-delà du tube digestif via une translocation d'épitopes bactériens et de l'autre, une communauté de facteurs génétiques et environnementaux partagés par différentes entités inflammatoires. Dans cette revue, nous aborderons les aspects cliniques des manifestations extra-intestinales et ses conséquences sur la prise en charge des MICI. Patients with Inflammatory Bowel Disease (IBD) experience at least one extra-intestinal manifestation (EIM) in up to 50% of the cases. EIM have a negative impact on the patient's quality of life and may interfere with treatment decision-making. EIMs are more common in CD than UC and there is a broad range of manifestations. The most prevalent EIMs in IBD are arthralgia/arthritis and skin manifestations. Most EIMs run in parallel with the intestinal disease activity but they may also have distinct course requiring multidisciplinary management. The pathogenesis of EIM in IBD is not univocal, combining a trigger immune response at the extraintestinal site due to translocation of bacterial epitopes and a shared community of genetic and environmental factors. This review focuses on the clinical features of EIM and consequences on the management of patients with IBD. [ABSTRACT FROM AUTHOR]