Evaluation of the excluded stomach by double-balloon endoscopy after laparoscopic Roux-en-Y gastric bypass
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Abstract
Background: Morbid obesity has become a serious health problem. We have been performing laparoscopic Roux-en-Y gastric bypass (LRYGBP) for morbid obesity since February 2002. Although LRYGBP ameliorates complications of morbid obesity, postoperative investigation of the excluded stomach is difficult. In patients with a family history of gastric cancer, resection of the bypassed stomach is sometimes added, but this requires longer operating time. There are two problems associated with LRYGBP: the high rate of gastric cancer in Japan, and how to investigate the excluded stomach.
Methods: To resolve these problems, we introduced double-balloon intestinal endoscopy. We report double-balloon endoscopy (DBE) in 4 patients.
Results: No problems with advancing the endoscope were encountered during observation. We used an overtube to insert the scope further in order to avoid forming redundant loops in the small intestine, and two balloons to grip the intestinal wall. Although performing DBE involves a learning curve, there were no major obstacles to passage of the scope into the esophagus, small gastric pouch, lifted jejunum, the jejunojejunal anastomosis, Y-loop, duodenum and excluded stomach.
Conclusion: Use of the double-balloon technique makes it possible to observe the GI tract after laparoscopic LRYGBP irrespective of the length between the gastrojejunostomy and the jejunojejunostomy.
Key words
Roux-en Y gastric bypass double-balloon endoscopy excluded stomach morbid obesity bariatric surgery intestinal metaplasiaPreview
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References
- 1.Sinar DR, Flickinger EG, Park HK et al. Retrograde endoscopy of the bypassed stomach segment after gastric bypass surgery: unexpected lesions. South Med J 1985; 78: 255–8.PubMedGoogle Scholar
- 2.Flickinger EG, Sinar DR, Pories WJ et al. The bypassed stomach. Am J Surg 1985; 149: 151–6.CrossRefPubMedGoogle Scholar
- 3.Meland JM. Radiological examination of the obese patient. In: Linner JH, ed. Surgery for Morbid Obesity. New York: Springer-Verlag 1984: 149–53.Google Scholar
- 4.McNeely GF, Stork JJ, Macgregor AMC et al. Percutaneous examination of the bypassed stomach. Obes Surg 1991; 1:427–30.CrossRefPubMedGoogle Scholar
- 5.Sundbom M, Nyman R, Hedenstrom H et al. Investigation of the excluded stomach after Roux-en Y gastric bypass. Obes Surg 2001; 11: 25–7.CrossRefPubMedGoogle Scholar
- 6.Fobi MAL, Chicola K, Lee H. Access to the bypassed stomach after gastric bypass. Obes Surg 1998; 8: 289–95.CrossRefPubMedGoogle Scholar
- 7.Silecchia G, Catalano C, Gentileschi P et al. Virtual gastroduodenoscopy: A new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2002; 12: 39–48.CrossRefPubMedGoogle Scholar
- 8.Sakai P, Kuga R, Safatle-Ribeiro AV et al. Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope. Endoscopy 2005; 37: 566–9.CrossRefPubMedGoogle Scholar
- 9.Yamamoto Y, Sekine Y, Sato Y et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216–20.CrossRefPubMedGoogle Scholar
- 10.Yamamoto Y, Sugano K. A new method of enteroscopy — the double-balloon method. Can J Gastroenterol 2003; 17: 273–4.PubMedGoogle Scholar
- 11.Raijman I, Stoher SV, Donegan WL. Gastric cancer after gastric bypass for obesity. J Clin Gastroenterol 1991; 13: 191–4.CrossRefPubMedGoogle Scholar
- 12.Lord RV, Edwards PD, Coleman MJ et al. Gastric cancer in the bypassed segment after operation for morbid obesity. Aust NZ J Surg 1997; 67: 580–2.CrossRefGoogle Scholar
- 13.Khitin L, Roses RE, Birkett DH. Cancer in the gastric remnant after gastric bypass: a case report. Curr Surg 2003; 60: 521–3.CrossRefPubMedGoogle Scholar
- 14.Escalona A, Guzman S, Ibanez L et al. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg 2005; 15: 423–7.CrossRefPubMedGoogle Scholar
- 15.Corsini DA, Simoneti CA, Moreira G et al. Cancer in the excluded stomach 4 years after gastric bypass. Obes Surg 2006; 16: 932–4.CrossRefPubMedGoogle Scholar
- 16.De Roover A, Detry O, De Leval L et al. Report of two cases of gastric cancer after bariatric surgery: lymphoma of the bypassed stomach after Roux-en-Y gastric bypass and gastrointestinal stromal tumor (GIST) after vertical banded gastroplasty. Obes Surg 2006; 16: 928–31.CrossRefPubMedGoogle Scholar
- 17.Wingo PA, Ries LA, Giovino GA et al. Annual report to the nation on the status of cancer, 1973–1996, with a special section on lung cancer and tabacco smoking. J Natl Cancer Inst 1999; 91: 675–90.CrossRefPubMedGoogle Scholar
- 18.Papadia FS, Scopinaro N. Gastric cancer and Roux-en-Y gastric bypass (Letter). Obes Surg 2006; 16: 1552.CrossRefPubMedGoogle Scholar
- 19.Calle E, Rodriguez C, Walker-Thurmond K et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625–38.CrossRefPubMedGoogle Scholar
- 20.Correa P. Is gastric cancer preventable? Gut 2004; 54: 1217–9.CrossRefGoogle Scholar
- 21.Voellinger D, Inabnet W. Laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy for focal intestinal metaplasia of the gastric antrum. Obes Surg 2002; 12: 695–8.CrossRefPubMedGoogle Scholar
- 22.El-Zimiaty HMT, Ramchatesingh J, Ali Saeed M et al. Gastric intestinal metaplasia: subtypes and natural history. J Clin Pathol 2001; 54: 679–83.Google Scholar
- 23.Leung WK, Lin SR, Wong WM et al. Factors predicting progression of gastric intestinal metaplasia: results of a randomized trial on Helicobacter pylori eradication. Gut 2004; 53: 1244–9.CrossRefPubMedGoogle Scholar