Abstract
Obesity is a major public health concern. As more bariatric surgical procedures are performed, the need for the endoscopist to recognize and treat early and late complications of weight loss surgical procedures is increasing. The types of anastomotic complication after bariatric surgery are very different, ranging from small ulceration successfully treated by medication, to anastomotic leak potentially life threatening. Before any endoscopic treatments, a comprehensive knowledge of postsurgical anatomy is mandatory.
This chapter provides an overview of the most common normal and pathological endoscopic findings. Incidence, causes, and natural history of post bariatric surgery anastomotic complications are described, as well as their endoscopic therapy.
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References
Parikh MS, Laker S, Weiner M et al (2006) Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg 202:252–261
Levitzky BE, Wassef WY (2010) Endoscopic management in the bariatric patient. Curr Opin Gastroenterol 26:632–639
Herron DM, Bloomberg R (2006) Complications of bariatric surgery. Minerva Chir 6:125–139
Wilson JA, Romagnuolo J, Byrne TK et al (2006) Predictors of endoscopic findings after Roux-en-Y gastric bypass. Am J Gastroenterol 101:2194–2199
Keith JN (2011) Endoscopic management of common bariatric surgical complications. Gastrointest Endosc Clin N Am 21:275–285
Sapala JA, Wood MH, Sapala MA et al (1998) Marginal ulcer after gastric by-pass: a prospective 3-year study of 173 patients. Obes Surg 8:505–516
MacLean LD, Rhode BM, Nohr C et al (1997) Stomal ulcer after gastric bypass. J Am Coll Surg 185:1–7
Carrodeguas L, Szomstein S, Soto F et al (2005) Management of gastrogastric fistulas after divided Roux-en Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of the literature. Surg Obes Relat Dis 1:467–474
Dallal RM, Bailey LA (2006) Ulcer diseases after gastric bypass surgery. Surg Obes Relat Dis 2:455–459
Garrido AB Jr, Rossi M, Lima SE Jr et al (2010) Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study. Arq Gastroenterol 47:130–134
Yu S, Jastrow K, Clapp B et al (2007) Foreign material erosion after laparoscopic Rouxen Y gastric bypass: findings and treatment. Surg Endosc 21:1216–1220
Csendes A, Burgos AM, Altuve J et al (2009) Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg 19:135–138
Gumbs AA, Duffy AJ, Bell RL (2006) Incidence and management of marginal ulceration after laparoscopic Roux-en Y gastric bypass. Surg Obes Relat Dis 2:460–463
Huang CS, Forse RA, Jacobsen BC et al (2003) Endoscopic findings and their clinical correlation in patients with symptoms after gastric bypass surgery. Gastrointest Endosc 58:859–866
Gumbs AA, Duffy AJ, Bell RL (2006) Management of gastrogastric fistula after laparoscopic Roux-en Y gastric bypass. Surg Obes Relat Dis 2:117–121
Schirmer BD (2006) Stricture and marginal ulcers in bariatric surgery. In: Buchwald H, Cowan GS, Pories W (eds) Surgical management of obesity. WB Saunders, Philadelphia, pp 297–303
Mittermair R, Renz O (2007) An unusual complication of gastric bypass: perforated duodenal ulcer. Obes Surg 17:701–703
Jamil LH, Krause KR, Chengelis DL et al (2008) Endoscopic management of early upper gastrointestinal hemorrhage following laparoscopic Roux-en-Y gastric bypass. Am J Gastroenterol 103:86–91
Paulk SC (1983) Formal dilation after gastric partitioning. Surg Gynecol Obstet 156:502–504
Podnos YD, Jimenez JC, Wilson SE et al (2003) Complications after laparoscopic gastric bypass. Arch Surg 138:957–961
Matthews BD, Sing RF, Delegge MH et al (2000) Initial results with a stapled gastrojejunostomy for the laparoscopic isolated Roux-en Y gastric bypass. Am J Surg 179:476–481
Peifer KJ, Shiels AJ, Azar R et al (2007) Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en Y gastric bypass. Gastrointest Endosc 66:248–252
Ukleja A, Afonso BB, Pimental R et al (2008) Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc 22:1746–1750
Ellsmere JC, Thompson CC, Brugge WR et al (2009) Endoscopic interventions for weight loss surgery. Obesity (Silver Spring) 17:929–933
Sanyal AJ, Sugerman HJ, Kellum JM, Wolfe L (1992) Stomach complication of gastric bypass: incidence and outcome of therapy. Am J Gastroenterol 87:1165–1169
Barba C, Butensky MS, Lorenzo M, Newman R (2003) Endoscopic balloon dilation of gastroenteric anastomotic stricture after gastric bypass. Surg Endosc 17:416–420
Ahmad J, Martin J, Ikramuddin S, Schauer P, Slivka A (2003) Endoscopic balloon dilation of gastroenteric anastomotic stricture after laparoscopic gastric bypass. Endoscopy 35:725–728
Go MR, Muscarella P, Needleman BJ, Cook CH, Melvin WS (2004) Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc 18:56–59
Boxbora A, Coskun H, Ozarmagan S et al (2000) A rare complication of adjustable gastric banding: Wernicke’s encephalopathy. Obes Surg 10:274–275
Filho AJ, Kondo W, Nassif LS et al (2006) Gastrogastric fistula: a possible complication of Roux-en Y gastric bypass. JSLS 10:326–331
Cucchi SG, Pories WJ, MacDonald KG et al (1995) Gastrogastric fistulas: a complication of divided gastric bypass surgery. Ann Surg 221:387–391
Papayramidis ST, Eleftheriadis EE, Papayramidis TS et al (2004) Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gatrointest Endosc 59:296–300
Papayramidis TS, Kotzampassi K, Kotidis E et al (2008) Endoscopic fibrin sealing of gastrocutaneous fistula after sleeve gastrectomy and biliopancreatic diversion with duodenal switch. J Gastroenterol Hepatol 23:1802–1805
Toussaint E, Eisendrath P, Kwan V et al (2009) Endoscopic treatment of postoperative enterocutaneous fistulas after surgery with the use of a fistula plug: report of five cases. Endoscopy 41:560–563
Eisendrath P, Cremer M, Himpens J et al (2007) Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy 39:625–630
Fernandez-Esparrach G, Lautz DB, Thompson CC (2010) Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis 6:282–288
Bhardwaj A, Cooney RN, Wehrman A et al (2010) Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience. Obes Surg 20:1090–1095
Fox SR, Srikanth MS (2006) Leaks and gastric disruption in bariatric surgery. In: Buchwald H, Cowan GS, Pories WJ (eds) Surgical management of obesity. WB Saunders, Philadelphia, pp 304–312
Higa KD, Boone KB, Ho T (2000) Complications on the laparoscopic Roux-en-y gastric bypass: 1,040 patients-what have we learned? Obes Surg 10:509–513
Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ (2008) Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 4(1):33–38, Epub 2007 Nov 5
Fernandez AZ (2004) Experience with over 3000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 18:193–197
Gonzalez R, Sarr MG, Smith CD et al (2007) Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 204(1):47–55
Doraiswamy A, Rasmussen JJ, Pierce J et al (2007) The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 21(12):2159–2162
Ganci-Cerrud G, Herrera MF (1999) Role of radiologic contrast studies in the early post operative period after bariatric surgery. Obes Surg 9(6):532–534
Merrifield BF, Lautz D, Thompson CC (2006) endoscopic repair of gastric leaks after roux-en-Y gastric bypass: a less invasive approach. Gastrointest Endosc 63:710–714
Eubanks S, Edwards CA, Fearing NM et al (2008) Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg 206:935–939
Serra C, Baltasar A, Andreo L et al (2007) Treatment of gastric leaks with coated selfexpanding stents after sleeve gastrectomy. Obes Surg 17:866–872
Barbor R, Talbot M, Tyndal A (2009) Treatment of upper gastrointestinal leaks with a removable, covered, self-expanding metallic stent. Surg Laparosc Endosc Percutan Tech 19:e1–e4
Garcia-Caballero M, Carbajo M, Martinez-Moreno JM et al (2005) Drain. Erosion and gastro-jejunal fistula after one-anastomosis gastric bypass: endoscopic occlusion by fibrin sealant. Obes Surg 15:719–722
Papavramidis ST, Eleftheriadis EE, Papavramidis TS et al (2004) Endoscopic. Management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc 59:296–300
Kriwanek S, Ott N, Ali-Abdullah S et al (2006) Treatment of gastro-jejunal. Leakage and fistulization after gastric bypass with coated selfexpanding stents. Obes Surg 16:1669–1674
Salinas A, Baptista A, Santiago E et al (2006) Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2:570–572
Fukumoto R, Orlina J, McGinty J et al (2007) Use of Polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis 3:68–71
Iqbal A, Miedema BW, Ramaswamy A et al (2011) Long-term outcome after endoscopic stent therapy for complications after bariatric surgery. Surg Endosc 25:505–520
Roberts KE, Duffy AJ, Bell RL (2007) Laparoscopic transgastric repair of a gastrogastric fistula after gastric bypass: a novel technique. Surg Innov 14:18–23
Torres-Villalobos G, Leslie D, Kellogg T et al (2007) A new approach for treatment of gastro-gastric fistula after gastric bypass. Obes Surg 17:242–246
Magro DO, Geloneze B, Delfini R et al (2008) Long-term weight regain after gastric bypass: a 5 year prospective study. Obes Surg 18:648–651
Karmali S, Stoklossa CJ, Sharma A et al (2010) Bariatric surgery: a primer. Can Fam Physician 56:873–879
Kofman MD, Lent MR, Swencionis C (2010) Maladaptive eating patterns, quality of life and weight outcomes following gastric bypass: result of an internet survey. Obesity (Silver Spring) 18:1938–1943
Mequid MM, Glade MJ, Middleton FA (2008) Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition 24:832–842
Salinas A, Baptista A, Santiago E, Antor M, Salinas H (2006) Self expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2(5):570–572
Brethauer SA, Nfonsam V, Sherman V et al (2006) Endoscopy and upper gastrointestinal contrast studies are complementary in evaluation of weight regain after bariatric surgery. Surg Obes Relat Dis 2:643–650
Spaulding L, Osler T, Patlak J (2007) Long-term results of sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Obes Relat Dis 3:623–626
Catalano MF, Rudic G, Anderson AJ et al (2007) Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc 66:240–245
Madan AK, Martiniz JM, Khan KA et al (2010) Endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass. J Laparoendosc Adv Surg Tech A 20:235–237
Spaulding L (2003) Treatment of dilated gastrojejunostomy with sclerotherapy. Obes Surg 13:254–257
Loewen M, Barba C (2008) Endoscopic sclerotherapy for dilated gastrojejunostomy of failed gastric bypass. Surg Obes Relat Dis 4:539–543
Ryou M, Mullady DK, Lautz DB et al (2009) Pilot study evaluating technical feasibility and early outcomes of a second-generation endosurgical platform for treatment of weight regain after gastric bypass surgery. Surg Obes Relat Dis 5:450–454
Mullady DK, Lautz DB, Thompson CC (2009) Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). Gastrointest Endosc 70:440–444
Thompson CC, Slattery J, Bundga ME et al (2006) Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc 20:1744–1748
Mikami D, Needleman B, Narula V et al (2010) Natural orifice surgery: initial US experience utilizing the StomaphyX device to reduce gastric pouches after Roux-en-Y gastric bypass. Surg Endosc 24:223–228
Hylen AM, Jacobs A, Lybeer M et al (2010) The OTSC-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery. Obes Surg 21:1629–1633
Tiffany MP, Amit Khera (2010) Current treatment options in cardiovascular medicine. Therapeutic Approaches to Obesity doi:10.1007/s11936-010-0080-y
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Genco, A., Maselli, R., Cipriano, M., Casella, G., Redler, A. (2014). Endoscopic Treatment of Anastomotic Complications After Bariatric Surgery. In: Galloro, G. (eds) Endoscopic Follow-up of Digestive Anastomosis. Springer, Milano. https://doi.org/10.1007/978-88-470-5370-0_16
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DOI: https://doi.org/10.1007/978-88-470-5370-0_16
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