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When the Endoscopist Needs the Surgeon

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Bariatric Therapy

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Abstract

Both in endoscopic bariatric therapy and in post-bariatric surgical complications where the endoscopist is consulted and called up for help, the endoscopist may request earnestly the assistance of a surgeon, a true cross-pollination between two specialisms and two specialists.

Examples in endoscopic bariatric therapy are cases of perforation during balloon insertion or caused by the balloon itself during its residence in the stomach. The duodenojejunal bypass sleeve has certain complications such as device migration, gastrointestinal bleeding and liver abscess during their stay and complications due to mechanical trauma upon removal such as oesophageal perforation. For some endoscopic bariatric therapies, the endoscopist has to rely on laparoscopic assistance such as with ValenTx oesophagogastroduodenal bypass sleeve and with the incisionless magnetic anastomotic system to create a jejunoileal bypass. Eventually, we should consider the possibility of “third-stage complication”, i.e. first a surgical complication that is treated by the endoscopist, which may then be followed by a potential complication of the endoscopy that should be treated by surgery. Examples thereof are stent migration, perforation after endoscopic dilation of a surgical stenosis, an intractable stenosis after many endoscopic dilations that need surgery again, secondary abscesses after endoscopic drainage that cannot be approached by radiology and a persistent fistula despite all endoscopic measures.

In post-bariatric surgical complications the endoscopist, on his/her turn, needs the assistance of the surgeon, as for instance in the access to the excluded stomach and the biliary tree. Then two teams of surgeons and endoscopists are needed for the laparoscopy-assisted ERCP (LA-ERCP) and the laparoscopic transgastric rendez-vous (LATG-RV) procedure.

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Abbreviations

BEA-ERCP:

Balloon enteroscopy-assisted ERCP

DJBS:

Duodenojejunal bypass sleeve

ERCP:

Endoscopic retrograde cholangiopancreaticography

IMAS:

Incisionless magnetic anastomotic system

IOP:

Incisionless Operating Platform

LA-ERCP:

Laparoscopy-assisted ERCP

LAGB:

Laparoscopic adjustable gastric banding

LATG-RV:

Laparoscopic assisted transgastric rendez-vous

POSE:

Primary Obesity Surgery Endoluminal

RYGB:

Roux-en-Y gastric bypass

SG:

Sleeve gastrectomy

TERIS:

Transoral endoscopic restrictive implant system

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Author information

Authors and Affiliations

  1. Amsterdam UMC (University Medical Centres), Amsterdam, The Netherlands

    Elisabeth M. H. Mathus-Vliegen

  2. Polyclinique Lyon Nord, Lyon, France

    Jérôme Dargent

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  1. Elisabeth M. H. Mathus-Vliegen
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  2. Jérôme Dargent
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Mathus-Vliegen, E.M.H., Dargent, J. (2018). When the Endoscopist Needs the Surgeon. In: Bariatric Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-90074-2_8

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  • DOI: https://doi.org/10.1007/978-3-319-90074-2_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90073-5

  • Online ISBN: 978-3-319-90074-2

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