Endoscopic Appearance After Foregut Surgery

  • David L. DiehlEmail author
  • Jon D. Gabrielsen


Approximately one in six patients presenting for upper endoscopy has had some prior reconstruction of the luminal anatomy. A knowledge and understanding of how to recognize these anatomic variants, as well as to diagnose and manage the complications that can arise from these surgeries, is extremely helpful to the junior endoscopist. The most common reasons for these surgeries include operations for peptic ulcer disease, anti-reflux surgery, resections for malignancy, and bariatric (weight loss) procedures. In some of these situations, biliary or pancreatic access is required, and a good understanding of the anatomy will help determine whether attempt at ERCP in a patient with altered anatomy should be pursued. The common use of anti-secretory medications (H2 receptor blockers and proton pump inhibitors) has made surgery for ulcer a rare event these days, but the increasing use of bariatric surgery for weight loss has made encounters with postoperative anatomy more frequent than even 10 years ago. This chapter will cover the major endoscopic findings of postoperative anatomy, with illustrative diagrams and endoscopic and fluoroscopic images.


Upper endoscopy Bariatric surgery Gastric anastomosis Billroth anastomosis Roux-Y gastric bypass Sleeve gastrectomy Fundoplication Esophagectomy Whipple resection 

Supplementary material

Video 8.1

Montage of video clips illustrating various postsurgical appearances. (MP4 365,741 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Gastroenterology and NutritionGeisinger Medical CenterDanvilleUSA
  2. 2.Department of General SurgeryGeisinger Medical CenterDanvilleUSA

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