Document Detail

Endoscopic management in the bariatric surgical patient.
MedLine Citation:
PMID:  20838343     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Morbid obesity is a global health epidemic. As the prevalence of bariatric surgery rises, it becomes increasingly important for gastroenterologists to understand their role in the perioperative care of bariatric surgical patients, to recognize potential complications of surgery that can be addressed endoscopically, and to learn about endoluminal approaches that may provide alternatives to bariatric surgery in the future.
RECENT FINDINGS: Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band account for more than 80% of weight loss procedures performed worldwide. Over two-thirds of patients with upper gastrointestinal symptoms following RYGB will have one or more abnormalities on endoscopy, including anastomotic strictures (53%), marginal ulcers (16%), functional obstructions (4%), and gastrogastric fistulas (2.6%). Intraoperative endoscopy can detect early leaks in over 7% of patients during RYGB surgery. Single-center experience finds that endoscopic repair of small gastrogastric fistulas is technically feasible in 95% of patients; however, durability of closure remains limited. Pooled data demonstrate that balloon-assisted endoscopic retrograde cholangiopancreatography can achieve papillary cannulation in 80% of patients with RYGB anatomy.
SUMMARY: The gastroenterologist can improve outcomes in bariatric surgical patients by understanding the issues of care that present themselves perioperatively and that lend themselves to minimally invasive endoscopic treatments.
Benjamin E Levitzky; Wahid Y Wassef
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in gastroenterology     Volume:  26     ISSN:  1531-7056     ISO Abbreviation:  Curr. Opin. Gastroenterol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-15     Completed Date:  2011-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8506887     Medline TA:  Curr Opin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  632-9     Citation Subset:  IM    
Department of Gastroenterology and Hepatology, University of Massachusetts Medical Center, Worcester, Massachusetts 01655, USA.
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MeSH Terms
Bariatric Surgery / adverse effects*,  methods*
Critical Pathways
Endoscopy, Gastrointestinal*
Obesity, Morbid / surgery*
Postoperative Complications
Preoperative Care

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