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El Djouzi S. Endoscopic Evaluation of the Bariatric Surgery Patient. THE SAGES MANUAL OF PHYSIOLOGIC EVALUATION OF FOREGUT DISEASES 2023:215-233. [DOI: 10.1007/978-3-031-39199-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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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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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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Evans JA, Muthusamy VR, Acosta RD, Bruining DH, Chandrasekhara V, Chathadi KV, Eloubeidi MA, Fanelli RD, Faulx AL, Fonkalsrud L, Khashab MA, Lightdale JR, Pasha SF, Saltzman JR, Shaukat A, Wang A, Stefanidis D, Richardson WS, Kothari SN, Cash BD. The role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2015; 81:1063-1072. [PMID: 25733126 DOI: 10.1016/j.gie.2014.09.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 12/22/2022]
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Evans JA, Muthusamy VR, Acosta RD, Bruining DH, Chandrasekhara V, Chathadi KV, Eloubeidi MA, Fanelli RD, Faulx AL, Fonkalsrud L, Khashab MA, Lightdale JR, Pasha SF, Saltzman JR, Shaukat A, Wang A, Stefanidis D, Richardson WS, Khothari SN, Cash BD. The role of endoscopy in the bariatric surgery patient. Surg Obes Relat Dis 2015; 11:507-517. [PMID: 26093766 DOI: 10.1016/j.soard.2015.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Tan QH, Dai YC. Etiology and non-surgical treatment of pyloric obstruction. Shijie Huaren Xiaohua Zazhi 2014; 22:4250-4256. [DOI: 10.11569/wcjd.v22.i28.4250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pyloric stenosis is a common type of upper gastrointestinal obstruction, which is a result of progression of many diseases. This paper will review the common causes of pyloric stenosis and its non-surgical treatments, mainly endoscopic treatment, in recent years. With the development of endoscopic technology, endoscopic treatment will gradually replace surgical treatment for treatment of pyloric obstruction.
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Lee HJ, Park W, Lee H, Lee KH, Park JC, Shin SK, Lee SK, Lee YC, Noh SH. Endoscopy-guided balloon dilation of benign anastomotic strictures after radical gastrectomy for gastric cancer. Gut Liver 2014; 8:394-9. [PMID: 25071904 PMCID: PMC4113056 DOI: 10.5009/gnl.2014.8.4.394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/29/2013] [Accepted: 07/16/2013] [Indexed: 12/27/2022] Open
Abstract
Background/Aims The aim of this study was to evaluate the outcome of endoscopic dilation for benign anastomotic stricture after radical gastrectomy in gastric cancer patients. Methods Gastric cancer patients who underwent endoscopic balloon dilation for benign anastomosis stricture after radical gastrectomy during a 6-year period were reviewed retrospectively. Results Twenty-one patients developed benign strictures at the site of anastomosis. The majority of strictures occurred within 1 year after surgery (95.2%). The median duration to stenosis after surgery was 1.70 months (range, 0.17 to 23.97 months). The success rate of the first endoscopic dilation was 61.9%. Between the restenosis group (n=8) and the no restenosis group (n=13), there were no significant differences in the body mass index (22.82 kg/m2 vs 22.46 kg/m2), interval to symptom onset (73.9 days vs 109.3 days), interval to treatment (84.6 days vs 115.6 days), maximal balloon diameter (14.12 mm vs 15.62 mm), number of balloon dilation sessions (1.75 vs 1.31), location of gastric cancer or type of surgery. One patient required surgery because of stricture refractory to repeated dilation. Conclusions Endoscopic dilation is a highly effective treatment for benign anastomotic strictures after radical gastrectomy for gastric cancer and should be considered a primary intervention prior to proceeding with surgical revision.
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Affiliation(s)
- Hyun Jik Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Ho Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Yang DH, Woo SI, Kim DH, Park SD, Jang JH, Kwan J, Shin SH. Two dislodged and crushed coronary stents: treatment of two simultaneously dislodged stents using crushing techniques. Korean J Intern Med 2013; 28:718-23. [PMID: 24307849 PMCID: PMC3846999 DOI: 10.3904/kjim.2013.28.6.718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 06/08/2012] [Accepted: 07/27/2012] [Indexed: 11/27/2022] Open
Abstract
Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex artery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, because the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent.
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Affiliation(s)
- Dong-Hyeok Yang
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Seong-Ill Woo
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Dae-Hyeok Kim
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Sang-Don Park
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Ji-Hun Jang
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Jun Kwan
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Sung-Hee Shin
- Department of Cardiology, Inha University Hospital, Incheon, Korea
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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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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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Boza C, Muñoz R, Salinas J, Gamboa C, Klaassen J, Escalona A, Pérez G, Ibañez L, Guzmán S. Safety and efficacy of Roux-en-Y gastric bypass to treat type 2 diabetes mellitus in non-severely obese patients. Obes Surg 2012; 21:1330-6. [PMID: 21744283 DOI: 10.1007/s11695-011-0463-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The efficacy of Roux-en-Y gastric bypass (RYGB) to control type 2 diabetes mellitus (T2DM) has been demonstrated in morbidly obese patients. Surgical procedures primarily focused on T2DM control in patients with body mass index (BMI) < 35 kg/m(2) have shown to effectively induce remission of T2DM. However, only few reports have evaluated the safety and efficacy of RYGB in this group of patients. The aim of this study is to assess the safety and efficacy of RYGB in TD2M patients with BMI < 35 kg/m(2). All T2DM patients with BMI < 35 kg/m(2) and at least 12 months of follow-up who underwent laparoscopic RYGB were included. Safety of the procedure was evaluated according to mortality, need of reoperation/conversion, and complication rates. Metabolic parameters were evaluated at baseline and 6, 12, and 24 months after surgery. Thirty patients were included. Seventeen (56.6%) were women. Age, BMI, and duration of diabetes were 48 ± 9 years, 33.7 ± 1.2 kg/m(2), 4 ± 2.9 years, respectively. No mortality was observed. No conversion/reoperation was needed. Average length of stay was 3.2 ± 0.9 days. Early and late postoperative complications were observed in five (16.6%) and five (16.6%) patients, respectively. Twelve months after surgery, remission was observed in 25 of 30 patients (83.3%). After 2 years, remission was achieved in 13 of 20 patients (65%), and hemoglobin A1c decreased from 8.1 ± 1.8% to 5.9 ± 1.1% and homeostasis model assessment of insulin resistance from 5.7 ± 3.2 to 1.9 ± 0.8 after 12 months. RYGB is a safe and effective procedure to induce T2DM remission in otherwise not eligible patients for bariatric surgery. Evidence from prospective studies is needed to validate this approach.
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Affiliation(s)
- Camilo Boza
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Boza C, Gamboa C, Salinas J, Achurra P, Vega A, Pérez G. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case-control study and 3 years of follow-up. Surg Obes Relat Dis 2011; 8:243-9. [PMID: 22285881 DOI: 10.1016/j.soard.2011.08.023] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 08/22/2011] [Accepted: 08/29/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a popular surgical procedure among bariatric surgeons. Few studies have compared the efficacy of the procedure to laparoscopic Roux-en-Y gastric bypass (LRYGB). We performed a case-control study to assess the surgical results, weight progression, and remission of co-morbid conditions. METHODS From January 2006 to September 2009, we selected 811 patients undergoing LSG as a primary procedure. These patients were matched by age, body mass index, and gender to 786 patients undergoing LRYGB. The complication rate, mortality, and percentage of excess weight loss after 1, 2, and 3 years were analyzed. RESULTS The mean age for the LRYGB and LSG groups was 37.0 ± 10.3 and 36.4 ± 11.7 years, respectively (P = .120). Most of the patients were women (LRYGB 76.6% versus LSG 76.2%; P = .855). The preoperative body mass index before surgery was similar in both groups (LRYGB 38.0 ± 3.2 versus LSG 37.9 ± 4.6 kg/m(2); P = .617). The mean operative time was longer for LRYGB (106.2 ± 33.2 versus 76.6 ± 28.0 min; P <.001), and the hospital stay was longer for LRYGB (3.4 ± 4.4 versus 2.8 ± .8 for LSG; P <.001). The early complication rate was 7.1% for LRYGB and 2.9% for LSG (P <.001), and the suture leak rate was .7% for LRYGB and .5% for LSG (P = NS). The percentage of excess weight loss for LRYGB versus LSG at 1, 2, and 3 years was 97.2% ± 24.3% versus 86.4% ± 26.4% (P <.001), 94.6% ± 30.2% versus 84.1% ± 28.3% (P <.001), and 93.1% ± 25.0% versus 86.8% ± 27.1% (P = .082), respectively. The total cholesterol level at 1 year for LRYGB versus LSG was 169.0 ± 32.9 versus 193.6 ± 38.7 mg/dL, respectively (P <.001), and the rate of diabetes remission was similar in both groups (LRYGB 86.6% versus LSG 90.9%). CONCLUSION LSG has become an acceptable primary bariatric procedure for obesity, with results comparable to LRYGB in this population.
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Affiliation(s)
- Camilo Boza
- Department of Digestive Surgery, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile.
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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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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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Taxonomy and imaging spectrum of small bowel obstruction after Roux-en-Y gastric bypass surgery. AJR Am J Roentgenol 2010; 194:120-8. [PMID: 20028913 DOI: 10.2214/ajr.09.2840] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE For most patients with morbid obesity, bariatric surgery is the only effective method to achieve sustainable weight loss. Small bowel obstruction (SBO) after bariatric surgery is a major complication that affects postoperative course and management. Knowledge of the types of and imaging findings for SBO is essential to prompt diagnosis. CONCLUSION We discuss different types of SBO and a taxonomic schemata of bowel obstruction (ABC classification) and present a review of imaging findings that facilitates optimal patient management.
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Csendes A, Burgos AM, Burdiles P. Incidence of anastomotic strictures after gastric bypass: a prospective consecutive routine endoscopic study 1 month and 17 months after surgery in 441 patients with morbid obesity. Obes Surg 2008; 19:269-73. [PMID: 18696171 DOI: 10.1007/s11695-008-9625-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 06/25/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic stricture after gastric bypass for morbid obesity has been reported as the most frequent complication after surgery. The objective of this study is to determine in a prospective and consecutive endoscopic evaluation the true incidence of this complication early and late after gastric bypass. METHODS A total of 441 morbidly obese patients were included in this prospective study. They were 358 women and 97 men, with a mean age of 41 years and a mean body mass index of 43 kg/m2. In all an endoscopic evaluation was performed 1 month after surgery, which was repeated in 315 patients (71.6%) 17 months after surgery, independent of the presence or not of symptoms. Anastomotic diameter was measured and strictures were classified as: (a) mild, with a diameter of 7 to 9 mm, (b) moderate with a diameter of 5 to 6 mm, and (c) difficult or critical with a diameter equal or less to 4 mm. Two methods of dilatation were employed: the endoscope itself or Savary-Gilliard dilators. Patients were submitted to laparotomic resectional gastric bypass in whom a circular stapler 25 was employed for gastrojejunal anastomosis or to laparoscopic gastric bypass, in whom hand-sewn one layer continuous suture was employed. RESULTS One month after surgery, 23% of patients after open gastric bypass employing circular stapler 25 presented anastomotic stricture, being 22% of them critical. After laparoscopic gastric bypass employing hand-sewn anastomosis, 36% of the patients presented strictures, being critical 10% (p>0.17). Patients with mild or moderate strictures needed one or two dilatations. Patients with critical strictures needed three to five dilatations. There were no complications associated to dilatation. Moderate and severe strictures were symptomatic; however 29% of patients with mild strictures were asymptomatic. Endoscopy was repeated in 71% of the whole group 17 months after surgery, demonstrating normal anastomosis in all. CONCLUSIONS Stricture at the gastrojejunal anastomosis after gastric bypass is the commonest complication early after surgery. Near 60% present a mild stricture (with a diameter between 7 and 9 mm), being 28% asymptomatic. This complication is easily treated by endoscopic procedure if it is diagnosed early (3 to 4 weeks) after surgery. Routine endoscopy 1 month after surgery is the only objective scientific way to determine the real true incidence of this complication.
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Affiliation(s)
- Attila Csendes
- Department of Surgery, University Hospital, University of Chile, Santiago, Chile.
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Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, Dominitz JA, Harrison ME, Ikenberry SO, Jagannath SB, Lichtenstein DR, Shen B, Lee KK, Van Guilder T, Stewart LE. Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2008; 68:1-10. [PMID: 18577471 DOI: 10.1016/j.gie.2008.01.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 01/16/2008] [Indexed: 12/13/2022]
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Fernández-Esparrach G, Bordas JM, Llach J, Lacy A, Delgado S, Vidal J, Cárdenas A, Pellisé M, Ginès A, Sendino O, Zabalza M, Castells A. Endoscopic dilation with Savary-Gilliard bougies of stomal strictures after laparosocopic gastric bypass in morbidly obese patients. Obes Surg 2008; 18:155-161. [PMID: 18176830 DOI: 10.1007/s11695-007-9372-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 11/13/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anastomotic strictures after bariatric surgery are a frequent complication that requires endoscopic management, but the optimal technique for dilation remains to be determined. The aim of this study was to evaluate the safety and efficacy of dilation with Savary-Gilliard bougies (SGB) in morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (RYGBP). PATIENTS AND METHODS Retrospective review of prospectively collected data from a series of 474 consecutive patients with laparoscopic bariatric surgery. Four-hundred twenty four of these patients (90%) underwent a laparoscopic RYGBP. A total of 24 patients were referred for anastomotic stricture dilation with SGB from January 1998 to December 2006. RESULTS A total of 24/424 patients (6%) developed a stricture that was successfully dilated with SGB. Patients were 17 females (71%) and seven males (29%) with a mean age of 41 +/- 11 years (range 24-63) and a mean BMI of 48 +/- 6 (range 40-69). The time between RYGBP and the appearance of stricture-related symptoms ranged from 29 to 154 days (mean, 69 days). The mean number of dilations was 1.6 +/- 0.6. The majority of patients required one (n = 11; 46%) or two (n = 12; 50%) dilations and only one patient required three dilations. During the initial dilation, a final diameter of 11 +/- 1.7 mm (range 7-12.8 mm) was achieved. In all cases, there was complete resolution of symptoms. There were no complications. CONCLUSIONS Dilation with SGB is an effective, safe, and durable method for managing anastomotic strictures after laparoscopic RYGBP.
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Affiliation(s)
- Glòria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, CIBER-ehd, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
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Bariatric procedures as day/short stay surgery: is it possible and reasonable? Curr Opin Anaesthesiol 2007; 20:508-12. [DOI: 10.1097/aco.0b013e3282f09443] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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