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World J Gastrointest Endosc. May 16, 2015; 7(5): 518-523
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.518
Endoscopic management of bariatric complications: A review and update
Caolan Walsh, Shahzeer Karmali
Caolan Walsh, Department of Surgery, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada
Shahzeer Karmali, Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alberta T5H 3V9, Canada
Author contributions: Walsh C and Karmali S equally contributed to this paper.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Caolan Walsh, MD, Department of Surgery, Dalhousie University, Victoria General Site, 1276 South Park Street, Room 849, Halifax, Nova Scotia B3H 2Y9, Canada. caolan.walsh@dal.ca
Telephone: +1-902-4737624 Fax: +1-902-4737639
Received: October 20, 2014
Peer-review started: October 20, 2014
First decision: November 27, 2014
Revised: December 6, 2014
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 16, 2015
Abstract

With over a third of Americans being considered obese, bariatric procedures have now become the most performed operation be general surgeons in the United States. The most common operations are the Laparoscopic Roux-en-Y Gastric Bypass, the Laparoscopic Sleeve Gastrectomy, and the Laparoscopic Adjustable Gastric Band. With over 340000 bariatric procedures preformed worldwide in 2011, the absolute number of complications related to these operations is also increasing. Complications, although few, can be life threatening. One of the most dreaded acute complication is the anastomotic/staple line leak. If left undiagnosed or untreated they can lead to sepsis, multi organ failure, and death. Smaller or contained leaks can develop into fistulas. Although most patients with an acute anastomotic leak return to the operating room, there has been a trend to manage the stable patient with an endoscopic stent. They offer an advantage by creating a barrier between enteric content and the leak, and will allow the patients to resume enteral feeding much earlier. Fistulas are a complex and chronic complication with high morbidity and mortality. Postoperative bleeding although rare may also be treated locally with endoscopy. Stenosis is a more frequent late complication and is best-managed with endoscopic therapy. Stents may not heal every fistula or stenosis, however they may prevent certain patients the need for additional revisional surgery.

Keywords: Bariatric surgery, Bariatric complications, Endoscopic treatment, Sleeve gastrectomy, Roux-en-Y gastric bypass, Anastomotic leak, Self-expanding metal stent

Core tip: The majority of general surgeons and all bariatric surgeons will be faced with complications related to bariatric surgery. Understanding the new anatomy and most frequent complications is paramount to treating these patients appropriately. The use of endoscopic self-expanding stents alone or in combination with an operation can stabilize and occasionally completely heal anastomotic leaks and fistulas. Endoscopy can also be useful in the diagnosis and treatment of bleeding, stenosis, and ulcerations. This review will summarize the current literature on endoscopy for bariatric complications.