Advertisement

Gastric Bypass pp 329-336 | Cite as

Endoscopic Treatment of Roux-en-Y Gastric Bypass Complications

  • Lyz Bezerra Silva
  • Gabriel Tavares Xavier Simplicio
  • Josemberg Marins Campos
Chapter
  • 33 Downloads

Abstract

The Roux-en-Y gastric bypass (RYGB) is effective and safe to treat obesity. However, the increasing number of bariatric procedures performed worldwide leads to an increase, in absolute number, of surgical complications such as leak, gastrojejunal stricture, weight regain, marginal ulcer, and ring complications.

The surgical approach was the first therapeutic option of these complications for a long time. However, revisional surgery is associated with elevated morbidity and mortality. Recently, due to its minimally invasive approach, endoluminal procedures are being increasingly used to treat these adverse outcomes, leading to bariatric endoscopy development. In this chapter we provide an overview of the most important bariatric endoscopy procedures to treat RYGB complications.

Keywords

Obesity Bariatric surgery Bariatric endoscopy Complications Leak Stents 

References

  1. 1.
    Campos JM, de Mello FST, Ferraz ÁAB, de Brito JN, Nassif PAN, dos Passos Galvão-Neto M. Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2012;25(4):283–9.CrossRefGoogle Scholar
  2. 2.
    Espinel J. Stenosis in gastric bypass: endoscopic management. World J Gastrointest Endosc. 2012;4(7):290.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    De Moura EGH, Orso IRB, Aurélio EF, De Moura ETH, De Moura DTH, Santo MA. Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(3):582–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Campos JM, Pereira EF, Evangelista LF, Siqueira L, Neto MG, Dib V, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21(10):1520–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Ferraz Á, Campos J, Dib V, Silva LB, De Paula PS, Gordejuela A, et al. Food intolerance after banded gastric bypass without stenosis: aggressive endoscopic dilation avoids reoperation. Obes Surg. 2013;23(7):959–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Coblijn UK, Lagarde SM, De Castro SMM, Kuiken SD, Van Tets WF, Van Wagensveld BA. The influence of prophylactic proton pump inhibitor treatment on the development of symptomatic marginal ulceration in Roux-en-Y gastric bypass patients: a historic cohort study. Surg Obes Relat Dis. 2016;12(2):246–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Kang X, Zurita-Macias L, Hong D, Cadeddu M, Anvari M, Gmora S. A comparison of 30-day versus 90-day proton pump inhibitor therapy in prevention of marginal ulcers after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(5):1003–7.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Moon RC, Teixeira AF, Goldbach M, Jawad MA. Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. Surg Obes Relat Dis. 2014;10(2):229–34.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Garrido AB, Rossi M, Lima SE, Brenner AS, Gomes CAR. Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment – prospective multicentric study. Arq Gastroenterol. 2010;47(2):130–4.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Campos JM, Evangelista LF, Ferraz ÁAB, Galvao Neto MP, De Moura EGH, Sakai P, et al. Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos). Gastrointest Endosc. 2010;72(1):44–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Taddeucci RJ, Madan AK, Ternovits CA, Tichansky DS. Laparoscopic re-operations for band removal after open banded gastric bypass. Obes Surg. 2007;17(1):35–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Marins Campos J, Moon RC, Magalhães Neto GEJ, Teixeira AF, Jawad MA, Bezerra Silva L, et al. Endoscopic treatment of food intolerance after a banded gastric bypass: inducing band erosion for removal using a plastic stent. Endoscopy. 2016;48(6):516–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Blero D, Eisendrath P, Vandermeeren A, Closset J, Mehdi A, Le Moine O, et al. Endoscopic removal of dysfunctioning bands or rings after restrictive bariatric procedures. Gastrointest Endosc. 2010;71(3):468–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Wilson TD, Miller N, Brown N, Snyder BE, Wilson EB. Stent induced gastric wall erosion and endoscopic retrieval of nonadjustable gastric band: a new technique. Surg Endosc. 2013;27(5):1617–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Bhayani NH, Swanström LL. Endoscopic therapies for leaks and fistulas after bariatric surgery. Surg Innov. 2014;21(1):90–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of 12,000 cases. Surg Obes Relat Dis 2012;8(1):8–19.Google Scholar
  17. 17.
    Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch Surg. 2016;401(6):757–66.PubMedCrossRefGoogle Scholar
  18. 18.
    Campos JM, Siqueira LT, Ferraz ÁAB, Ferraz EM. Gastrobronchial fistula after obesity surgery. J Am Coll Surg. 2007;204(4):711.PubMedCrossRefGoogle Scholar
  19. 19.
    Zundel N, Hernandez JD. Strictures after laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):154–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Baretta G, Campos J, Correia S, Alhinho H, Marchesini JB, Lima JH, et al. Bariatric postoperative fistula: a life-saving endoscopic procedure. Surg Endosc Other Interv Tech. 2015;29(7):1714–20.CrossRefGoogle Scholar
  21. 21.
    Schmidt F, Mennigen R, Vowinkel T, Neumann PA, Senninger N, Palmes D, et al. Endoscopic Vacuum Therapy (EVT)—a new concept for complication management in bariatric surgery. Obes Surg. 2017;27(9):2499–505.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Rebibo L, Hakim S, Brazier F, Dhahri A, Cosse C, Regimbeau JM. New endoscopic technique for the treatment of large gastric fistula or gastric stenosis associated with gastric leaks after sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(8):1577–84.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Quezada N, Maiz C, Daroch D, Funke R, Sharp A, Boza C, et al. Effect of early use of covered self-expandable endoscopic stent on the treatment of postoperative stapler line leaks. Obes Surg. 2015;25(10):1816–21.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Puig CA, Waked TM, Baron TH, Wong Kee Song LM, Gutierrez J, Sarr MG. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis. 2014;10(4):613–9.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Donatelli G, Dumont J, Cereatti F, Dhumane P, Tuszynski T, Vergeau B, et al. Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series. Endosc Int Open. 2016;04(06):E647–51.CrossRefGoogle Scholar
  26. 26.
    Christophorou D, Valats J, Funakoshi N, Duflos C, Picot M, Vedrenne B, et al. Endoscopic treatment of fistula after sleeve gastrectomy: results of a multicenter retrospective study. Endoscopy. 2015;47:988–96.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Campos JM, Ferreira FC, Teixeira AF, Lima JS, Moon RC, D’Assunção MA, et al. Septotomy and balloon dilation to treat chronic leak after sleeve gastrectomy: technical principles. Obes Surg. 2016;26(8):1992–3.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Shehab H, Abdallah E, Gawdat K, Elattar I. Large bariatric-specific stents and over-the-scope clips in the management of post-bariatric surgery leaks. Obes Surg. 2018;28(1):15–24.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Southwell T, Lim TH, Ogra R. Endoscopic therapy for treatment of staple line leaks post-laparoscopic sleeve gastrectomy (LSG): experience from a Large Bariatric Surgery Centre in new Zealand. Obes Surg. 2016;26(6):1155–62.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Tringali A, Bove V, Perri V, Landi R, Familiari P, Boškoski I, et al. Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent. Endoscopy. 2017;49(1):64–8.PubMedGoogle Scholar
  31. 31.
    Klimczak T, Klimczak J, Szewczyk T, Janczak P, Jurałowicz P. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents. Surg Endosc Other Interv Tech. 2017;32(4):1–8.Google Scholar
  32. 32.
    Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, et al. Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Obes Surg. 2014;24(8):1400–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Mahadev S, Kumbhari V, Campos JM, Galvao Neto M, Khashab MA, Chavez YH, et al. Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections. Endoscopy. 2017;49(5):504–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Shnell M, Gluck N, Abu-Abeid S, Santo E, Fishman S. Use of endoscopic septotomy for the treatment of late staple-line leaks after laparoscopic sleeve gastrectomy. Endoscopy. 2017;49(1):59–63.PubMedGoogle Scholar
  35. 35.
    Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;12(7):1278–85.PubMedCrossRefGoogle Scholar
  36. 36.
    Vix M, Marx L, Diana M, Perretta S, Donatelli G, Callari C, et al. Management of staple line leaks after sleeve gastrectomy in a consecutive series of 378 patients. Surg Endosc Other Interv Tech. 2012;26(1):S207.Google Scholar
  37. 37.
    Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687–92.PubMedCrossRefGoogle Scholar
  38. 38.
    Lorenzo D, Guilbaud T, Gonzalez JM, Benezech A, Dutour A, Boullu S, et al. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc. 2017;87(2):429–37.PubMedCrossRefGoogle Scholar
  39. 39.
    Seyfried F, Reimer S, Miras AD, Kenn W, Germer CT, Scheurlen M, et al. Successful treatment of a gastric leak after bariatric surgery using endoluminal vacuum therapy. Endoscopy. 2013;45(SUPPL2):267–9.Google Scholar
  40. 40.
    Dayyeh BKA, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. YJCGH. 2011;9(3):228–33.Google Scholar
  41. 41.
    Brunaldi VO, Jirapinyo P, De MDTH, Okazaki O, Bernardo WM, Neto MG, et al. Endoscopic treatment of weight regain following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg. 2017;28(1):266–76.CrossRefGoogle Scholar
  42. 42.
    Ramos AC, Marchesini JC, de Souza Bastos EL, Ramos MG, de Souza MDG, Campos JM, et al. The role of gastrojejunostomy size on gastric bypass weight loss. Obes Surg. 2017;27(9):2317–23.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Schulman AR, Kumar N, Thompson CC. Transoral outlet reduction: a comparison of purse-string with interrupted stitch technique. Gastrointest Endosc. 2018;87(5):1222–8.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Baretta GAP, Alhinho HCAW, Matias JEF. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass. Obes Surg. 2014;25(1):72–9.CrossRefGoogle Scholar
  45. 45.
    Moon RC, Teixeira AF, Neto MG, Zundel N, Sander BQ, Ramos FM, et al. Efficacy of utilizing argon plasma coagulation for weight regain in Roux-en-Y gastric bypass patients: a Multi-center Study. Obes Surg. 2018;28(9):2737–44.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc. 2016;83(4):776–9.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Jirapinyo P, Kröner PT, Thompson CC. Purse-string transoral outlet reduction (TORe) is effective at inducing weight loss and improvement in metabolic comorbidities after Roux-en-Y gastric bypass. Endoscopy. 2018;50(4):371–7.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Patel LY, Lapin B, Brown CS, Stringer T, Gitelis ME, Linn JG, et al. Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction. Surg Endosc. 2017;31(6):2667–77.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Lyz Bezerra Silva
    • 1
  • Gabriel Tavares Xavier Simplicio
    • 1
  • Josemberg Marins Campos
    • 2
  1. 1.Department of SurgeryFederal University of PernambucoRecifeBrazil
  2. 2.Surgery DepartmentUniversity Hospital, Pernambuco Federal UniversityRecifeBrazil

Personalised recommendations