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BackgroundSilastic rings are used in gastric bypass procedures for the treatment of obesity, but ring slippage may lead to gastric pouch outlet stenosis (GPOS). Conventional management has been ring removal through abdominal surgery.ObjectiveTo describe a novel, safe, minimally invasive, endoscopic technique for the treatment of GPOS caused by ring slippage after gastric bypass.DesignCase series.SettingFederal University of Pernambuco and São Paulo University.PatientsThis study involved 39 consecutive patients who were screened for inclusion.InterventionEndoscopic dilation with an achalasia balloon.Main Outcome MeasurementsTechnical success and safety of the procedure.ResultsAmong the 39 patients, 35 underwent endoscopic dilation at the ring slippage site for the relief of GPOS. The 4 patients who did not undergo endoscopic dilation underwent surgical removal of the ring, based on the exclusion criteria. The endoscopic approach was successful in 1 to 4 sessions in 100% of cases with radioscopic control (n = 12). The duration of the procedures ranged from 5 to 30 minutes, and the average internment was 14.4 hours. Dilation promoted either rupture (65.7%) or stretching (34.3%) of the thread within the ring, thereby increasing the luminal diameter of the GPOS. Complications included self-limited upper digestive tract hemorrhage (n = 1) and asymptomatic ring erosion (n = 4). There were no recurrences of obstructive symptoms during the follow-up period (mean of 33.3 months).LimitationsThis was not a randomized, comparison study, and the number of patients was relatively small.ConclusionThe technique described promotes the relief of GPOS with low overall morbidity and avoids abdominal reoperation for ring removal. [ABSTRACT FROM AUTHOR]