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Argyriou K, Parra-Blanco A. Reconstructing the puzzle of the role of therapeutic endoscopy in the management of post-bariatric surgery complications. World J Gastroenterol 2022; 28:2633-2635. [PMID: 35949348 PMCID: PMC9254138 DOI: 10.3748/wjg.v28.i23.2633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
We have recently read with interest the mini-review article "Therapeutic endoscopy for the treatment of post-bariatric surgery complications". The abovementioned article is a brief overview of the different endoscopic modalities employed in the management of bariatric surgery complications and represents an important decision support tool for clinicians to improve their current practice. Although we appreciate the endeavor of Larsen and Kozarek, based on our in-depth analysis, we came across several minor issues in this article; thus, we present our comments in this letter. In case the authors contemplate these comments in their relevant research, we believe that their contribution would be considerable for future studies.
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Affiliation(s)
- Konstantinos Argyriou
- Department of Gastroenterology, University Hospital of Larisa, Larisa GR41110, Greece
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, United Kingdom
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2
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Palermo M, Davrieux F, Serra E, Giménez M. Percutaneous Image-Guided Surgery in Complications After Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2020; 30:967-972. [DOI: 10.1089/lap.2020.0410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mariano Palermo
- CIEN-DIAGNOMED Center Affiliated to the University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Buenos Aires, Argentina
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Federico Davrieux
- DAICIM Foundation, Buenos Aires, Argentina
- Department of General Surgery, Sanatorio de la Mujer, Rosario, Argentina
| | - Edgardo Serra
- CIEN-DIAGNOMED Center Affiliated to the University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Buenos Aires, Argentina
| | - Mariano Giménez
- DAICIM Foundation, Buenos Aires, Argentina
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire-Strasbourg, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
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Percutaneous Image-Guided Abdominal Interventions for Leaks and Fistulas Following Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Obes Surg 2019; 29:2051-2058. [DOI: 10.1007/s11695-019-03824-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results. World J Gastrointest Endosc 2017; 9:105-126. [PMID: 28360973 PMCID: PMC5355758 DOI: 10.4253/wjge.v9.i3.105] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.
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Malli CP, Sioulas AD, Emmanouil T, Dimitriadis GD, Triantafyllou K. Endoscopy after bariatric surgery. Ann Gastroenterol 2016; 29:249-257. [PMID: 27366025 PMCID: PMC4923810 DOI: 10.20524/aog.2016.0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/08/2016] [Indexed: 12/16/2022] Open
Abstract
Obesity is a global epidemic with significant morbidity and mortality. Weight loss results in reduction of health risks and improvement in quality of life, thus representing a goal of paramount importance. Bariatric surgery is the most efficacious choice compared to conservative alternatives including diet, exercise, drugs and behavioral modification to treat obese patients. Following bariatric operations, patients may present with upper gastrointestinal tract complaints that warrant endoscopic evaluation and the various bariatric surgery types are often linked to complications. A subset of these complications necessitates endoscopic interventions for accurate diagnosis and effective, minimal invasive treatment. This review aims to highlight the role of upper gastrointestinal endoscopy in patients who have undergone bariatric surgery to evaluate and potentially treat surgery-related complications and upper gastrointestinal symptoms.
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Affiliation(s)
- Chrysoula P. Malli
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Athanasios D. Sioulas
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Theodoros Emmanouil
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - George D. Dimitriadis
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
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de Moura EGH, Orso IRB, Aurélio EF, de Moura ETH, de Moura DTH, Santo MA. Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2016; 12:582-586. [PMID: 27174245 DOI: 10.1016/j.soard.2015.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/02/2015] [Accepted: 11/11/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Roux-en-Y gastric bypass is a commonly used technique of bariatric surgery. One of the most important complications is gastrojejunal anastomotic stricture. Endoscopic balloon dilation appears to be well tolerated and effective, but well-designed randomized, controlled trials have not yet been conducted. OBJECTIVE Identify factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery. SETTING Gastrointestinal endoscopy service, university hospital, Brazil. METHODS The records of 64 patients with anastomotic stricture submitted to endoscopic dilation with hydrostatic balloon dilation were reviewed. Information was collected on gastric pouch length, anastomosis diameter before dilation, number of dilation sessions, balloon diameter at each session, anastomosis diameter after the last dilation session, presence of postsurgical complications, endoscopic complications, and outcome of dilation. Comparisons were made among postsurgical and endoscopic complications; number of dilations, balloon diameter; anastomosis diameter before dilation; and dilation outcome. RESULTS Success of dilation treatment was 95%. Perforation was positively and significantly associated with the number of dilation sessions (P = .03). Highly significant associations were found between ischemic segment and perforation (P<.001) and between ischemic segment and bleeding (P = .047). Ischemic segment (P = .02) and fistula (P = .032) were also associated with dilation failure. CONCLUSION Ischemic segment and fistula were found to be important risk factors for balloon dilation failure. The greater the number of dilation sessions, the greater the number of endoscopic complications.
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Affiliation(s)
- Eduardo G H de Moura
- Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Gastrointestinal Endoscopy Service, Hospital São Luiz Morumbi, São Paulo, Brazil
| | - Ivan R B Orso
- Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Gastroclínica Cascavel - Assis Gurgacz Medical School, Paraná, Brazil.
| | - Eduardo F Aurélio
- Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Eduardo T H de Moura
- Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Diogo T H de Moura
- Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco A Santo
- Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Campos JM, Mello FSTD, Ferraz AAB, Brito JND, Nassif PAN, Galvão-Neto MDP. Endoscopic dilation of gastrojejunal anastomosis after gastric bypass. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:283-9. [PMID: 23411930 DOI: 10.1590/s0102-67202012000400014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/17/2012] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. AIM Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates. METHODS The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded. RESULTS The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain. CONCLUSION Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings.
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Kumar N, Thompson CC. Endoscopic management of complications after gastrointestinal weight loss surgery. Clin Gastroenterol Hepatol 2013; 11:343-53. [PMID: 23142331 DOI: 10.1016/j.cgh.2012.10.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/23/2012] [Accepted: 10/26/2012] [Indexed: 02/07/2023]
Abstract
As more patients undergo bariatric surgery, gastroenterologists will increasingly encounter variant postsurgical anatomies and postoperative complications. We discuss the diagnosis and management of bleeding, ulcers, foreign bodies, stenoses, leaks, fistulas, pancreaticobiliary diseases, weight regain, and dilated outlets.
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Affiliation(s)
- Nitin Kumar
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Espinel J, Pinedo E. Stenosis in gastric bypass: Endoscopic management. World J Gastrointest Endosc 2012; 4:290-5. [PMID: 22816008 PMCID: PMC3399006 DOI: 10.4253/wjge.v4.i7.290] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 05/02/2012] [Accepted: 07/01/2012] [Indexed: 02/05/2023] Open
Abstract
Gastric bypass is a treatment option for morbid obesity. Stenosis of the gastrojejunal anastomosis is a recognized complication. The pathophysiological mechanisms involved in the formation of stenosis are not well known. Gastrojejunal strictures can be classified based on time of onset, mechanism of formation, and endoscopic aspect. Diagnosis is usually obtained by endoscopy. The two main treatment alternatives for stomal stricture are: endoscopic dilatation (balloon or bouginage) and surgical revision (open or laparoscopic). Both techniques of dilation [through-the-scope (TTS) balloon dilators, Bougienage dilators] are considered safe, effective, and do not require hospitalization. The optimal technique for dilation of stomal strictures remains to be determined, but many authors prefer the use of TTS balloon catheters. Most patients can be successfully treated with 1 or 2 sessions. The need for reconstructive surgery of a stomal stricture is extremely rare.
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Affiliation(s)
- Jesús Espinel
- Jesús Espinel, Endoscopy Unit, Gastroenterology Department, Hospital de León, 24071 León, Spain
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Marcotte E, Comeau E, Meziat-Burdin A, Ménard C, Rateb G. Early migration of fully covered double-layered metallic stents for post-gastric bypass anastomotic strictures. Int J Surg Case Rep 2012; 3:283-6. [PMID: 22516420 DOI: 10.1016/j.ijscr.2012.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/24/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Laparoscopic Roux-en-Y gastric bypass (LRYGB) is well recognized for its efficiency in morbidly obese patients. Anastomotic strictures present in 5-15% of cases and have a significant impact on the patient's quality of life. Endoscopic balloon dilation is the recommended treatment but management of refractory cases is challenging. PRESENTATION OF CASE Two patients with anastomotic stenoses refractory to dilations were treated with fully covered esophageal stents. Both cases presented early stent migration. The first patient finally underwent surgical revision of the anastomosis. For the second patient, a double-layered stent was installed after the first incident. After the migration of this second stent, three sessions of intralesional injection of triamcinolone acetonide were performed. Both patients were free of obstructive symptoms at a follow-up of 9 months. DISCUSSION Treatment of post-gastric bypass strictures with stents is based on years of successful experience with endoscopic stenting of malignant esophageal strictures, gastric outlet obstruction in addition to anastomotic stenoses after esophageal cancer surgery. The actual prosthesis are however inadequate for the particularities of the LRYGB anastomosis with a high migration rate. Intralesional corticosteroid injection therapy has been reported to be beneficial in the management of refractory benign esophageal strictures and seems to have prevented recurrence of the stenosis in this post-LRYGB. CONCLUSION Stents are aimed at preventing a complex surgical reintervention but are not yet specifically designed for that indication. Local infiltration of corticosteroids at the time of dilation may prevent recurrence of the anastomotic stricture.
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Affiliation(s)
- Eric Marcotte
- Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada J1H 5N4
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Abstract
Obesity and its associated conditions, including type 2 diabetes and cardiovascular disease, have reached epidemic proportions. Gastrointestinal weight loss surgery (GIWLS) shows the most promise in achieving significant and sustained weight loss and diabetes resolution. However, a large mismatch exists between the magnitude of the obesity epidemic and the number of surgical procedures performed to produce a significant shift in the distribution of obesity on a population level. This mismatch is fueled by high surgical costs, morbidity and mortality associated with surgical interventions, and the fact that the greatest public health burden of obesity comes from those around the center of the population body mass index distribution with mild to moderate obesity, rather than those at the distribution tail with severe obesity that GIWLS targets. New endoscopic methods, capitalizing on advances in our understanding of the physiological mechanisms by which GIWLS works, are developing to provide viable alternatives in the treatment of bariatric surgical complications, and for the primary treatment of obesity. These methods may have the added advantage of reduced invasiveness, reversibility, cost-effectiveness, and applicability to a larger segment of the population with moderate obesity.
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Affiliation(s)
- Barham K. Abu Dayyeh
- Gastrointestinal Unit, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Christopher C. Thompson
- Assistant Professor of Medicine, Harvard Medical School, and Director, Developmental and Bariatric Endoscopy, Gastroenterology Division, Brigham and Women’s Hospital, 75 Francis Street, Thorn 14, Boston, MA 02115, USA
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Da Costa M, Mata A, Espinós J, Vila V, Roca JM, Turró J, Ballesta C. Endoscopic dilation of gastrojejunal anastomotic strictures after laparoscopic gastric bypass. Predictors of initial failure. Obes Surg 2011; 21:36-41. [PMID: 20396992 DOI: 10.1007/s11695-010-0154-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most frequent technique performed in bariatric surgery. Gastrojejunal anastomotic stricture is one of the most common postoperative complications. The aims of this study were to evaluate the efficacy and safety of endoscopic balloon dilation in the treatment of the gastrojejunal anastomotic strictures after LRYGB and to look for predicting factors that would indicate the need of repeated dilations. METHODS We included all patients with morbid obesity who underwent a LRYGB at our institution between January 2002 and July 2007. All patients who developed symptoms compatible with stricture of the gastrojejunostomy were referred to upper gastrointestinal endoscopy and underwent endoscopic balloon dilation. RESULTS One hundred and five out of the 1,330 patients (7.8%) developed an anastomotic stricture. The mean time to diagnosis was 3 months after the surgery. The mean diameter of the stricture was 5 mm. Sixty out of the 105 patients required only one dilation (57%), 29 required two dilations (27,6%), 13 required three dilations, and 3 patients underwent a fourth dilation. Clinical success was achieved in 100% of the cases, with an average of 1.6 dilations. The statistical analysis showed that only the time from surgery to stricture formation (p = 0.007) and the diameter achieved at the first dilation (p = 0.015) had statistical significance as predictors of the need of one or more dilations. CONCLUSIONS Endoscopic balloon dilation is a safe and effective method. Most of the patients are successfully managed with one or two dilations. The longer time from surgery to the appearance of symptoms ant the largest diameter achieved at the first dilation are the only predicting factors of success with only one dilation.
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Fernández-Esparrach G, Córdova H, Bordas JM, Gómez-Molins I, Ginès A, Pellisé M, Sendino O, González-Suárez B, Cárdenas A, Balderramo D, Lacy AM, Delgado S, Llach J. [Endoscopic management of the complications of bariatric surgery. Experience of more than 400 interventions]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:131-136. [PMID: 21377237 DOI: 10.1016/j.gastrohep.2010.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/16/2010] [Accepted: 12/24/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many patients who undergo bariatric surgery develop postoperative gastrointestinal complications that can require upper gastrointestinal endoscopy. OBJECTIVE To prospectively describe the gastrointestinal complications diagnosed by endoscopy after bariatric surgery. PATIENTS AND METHODS We followed up patients undergoing laparoscopic bariatric surgery between January 1998 and December 2006. The following data were recorded: age, sex, body mass index, comorbidity, type and duration of bariatric surgery, clinical presentation of complications, time of presentation, endoscopic treatment and follow-up. RESULTS A total of 474 patients underwent surgery (74% women, 26% men) with a mean age of 44±11 years (range, 15-66) and a mean BMI of 47±7 (range, 33-82). The most frequent surgical procedure was Roux-en-Y gastric bypass (90%). We identified 68 complications (14%) requiring upper gastrointestinal endoscopy: anastomotic stenosis (21 cases, 5%), upper gastrointestinal hemorrhage (16 cases, 3.6%), epigastric pain (12 cases, 2.5%), vomiting (7 cases, 1.5%), heartburn (6 cases, 1.3%) and other (6 cases, 1.3%). No prognostic factor for the development of complications requiring postsurgical endoscopy was identified. CONCLUSIONS Anastomotic stenosis is the most common complication requiring endoscopic treatment after bariatric surgery. Upper gastrointestinal bleeding in the immediate and late postoperative period can be safely and effectively treated with endoscopic techniques.
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Affiliation(s)
- Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBEREHD, España.
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Potack J. Management of post bariatric surgery anastomotic strictures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2010.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gastrojejunal Anastomotic Stenosis in Laparoscopic Gastric Bypass with a Circular Stapler (21 mm): Incidence, Treatment and Long-term Follow-up. Obes Surg 2009; 19:1631-35. [DOI: 10.1007/s11695-009-9962-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 08/17/2009] [Indexed: 11/30/2022]
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Ellsmere JC, Thompson CC, Brugge WR, Chuttani R, J Desilets D, Rattner DW, E Tarnoff M, Kaplan LM. Endoscopic interventions for weight loss surgery. Obesity (Silver Spring) 2009; 17:929-33. [PMID: 19396074 DOI: 10.1038/oby.2008.588] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this paper we review the state-of-the-art in endoscopic interventions for obesity treatment and make best practice recommendations for weight loss surgery (WLS). We performed a systematic search of English-language literature published between April 2004 and June 2008 in MEDLINE and the Cochrane Library on WLS and endoscopic interventions, endoscopically placed devices, minimally invasive surgery, image-guided surgery, endoluminal surgery, endoscopic instrumentation, interventional gastroenterology, transluminal surgery, and natural orifice transluminal surgery. We also searched the literature on endoscopic interventions and WLS and patient safety. We identified 36 pertinent articles, all of which were reviewed in detail; assessed the current science in endoscopic interventions for WLS; and made best practice recommendations based on the latest available evidence. Our findings indicate that endoscopic interventions and endoscopically placed devices may provide valuable approaches to the management of WLS complications and the primary management of obesity. Given the rapid changes in endoscopic technologies and techniques, systematic literature review is required to address issues related to the emerging role of endoluminal surgery in the treatment of obesity. These interventions should be a high priority for development and investigation.
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Affiliation(s)
- James C Ellsmere
- Section of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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