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Feasibility and Importance of Enteroscopy after Gastric Bypass

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Abstract

Background

Bariatric surgery has increased in popularity, with Roux-en-Y Gastric Bypass (RYGB) being one of the most frequently performed. This leads to many cases in which the stomach is removed from routine gastroscopy access, sometimes being a major source of concern. Performing enteroscopy in these patients is technically difficult. We present our experience with 24 cases in which the aim was to access the detached stomach.

Methods

Retrospective analysis on RYGB enteroscopy procedures aimed to access the detached stomach. Data recorded: demographic parameters, indication, gas insufflation, time to bypass stomach, total procedure and recovery times, and endoscopic and pathological findings.

Results

This study included 24 patients who underwent RYGB in the previous 3–36 months. Indications were chronic abdominal pain, refractory anemia, or unexplainable weight loss. Detached stomach was accessed in 79% of patients. Access time ranged from 25 to 55 min. Recovery time for all procedures was 86.66 min on average and shorter with CO2 insufflation (42.5 min). All detached stomachs showed macroscopic gastritis; four of them were Helicobacter pylori positive. Significant findings included three patients with jejunojejunostomy stenosis and one patient with a marginal gastrojejunal ulcer, which was later diagnosed with Signet ring cell carcinoma of the proximal anastomosis.

Conclusions

We present the feasibility and importance of enteroscopy of the detached stomach and believe that this procedure should be performed more frequently. A high index of suspicion is needed for postoperative symptoms in order to exclude significant pathologies and reassure symptomatic patients that there is no abnormality in the bypassed stomach.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Bnai-Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Golomb 47, 31048, Haifa, Israel

    Dean Keren & T. Rainis

  2. Bariatric Gastroenterology Clinic – Gastroenterology Unit, Bnai-Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel

    Dean Keren

  3. Department of General Surgery, Bnai-Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Golomb 47, 31048, Haifa, Israel

    H. Madi & I. Matter

  4. Division of Advanced Laparoscopic and Bariatric Surgery, Department of General Surgery, Rambam Healthcare Campus and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    A. Assalia

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  1. Dean Keren
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Correspondence to Dean Keren.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Dr. Keren, Dr. Madi, Dr. Matter, Dr. Assalia and Dr. Rainis declare that they have no conflict of interest.

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Keren, D., Madi, H., Matter, I. et al. Feasibility and Importance of Enteroscopy after Gastric Bypass. OBES SURG 27, 1309–1315 (2017). https://doi.org/10.1007/s11695-016-2472-x

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  • DOI: https://doi.org/10.1007/s11695-016-2472-x

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