Endoscopic Approach for Major Complications of Bariatric Surgery

Joo, Moon Kyung

doi:10.5946/ce.2016.140

Cited by 45 publications

(53 citation statements)

References 98 publications

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“…Interestingly, LOAGB complications may be divided into anastomosis-related stricture and leaks which resemble those of RYGB [24][25][26], and staple line leaks and remnant stomach axis deviation (kink) which are similar to those of LSG [27][28][29]. Our data show a 100% (7/7) success rate in TTS dilation of anastomotic strictures without any complications at a mean follow up of 6 months, similar to the 93-100% success rate for post RYGB anastomotic stricture dilation [30]. Anastomotic leaks controlled with stent insertion also exhibited a favorable outcome with 100% success (3/3).…”

Section: Discussionsupporting

confidence: 71%

“…Anastomotic leaks controlled with stent insertion also exhibited a favorable outcome with 100% success (3/3). In contrast, treatment of staple line leaks exhibited a less favorable outcome with a success rate of only 20% (1/5), compared to 65-95% in acute and early leaks after LSG [30]. Of note, two patients evolved to a late type of leak and received ancillary drainage with septotomy and double pigtail stent.…”

Section: Discussionmentioning

confidence: 93%

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Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

et al. 2020

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Background: Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods: This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-thescope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results: Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation. Conclusion: Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 93%

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

et al. 2020

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“…Stenosis commonly presents at a rate of 2-12% and at 4-8 weeks after an LRYGB operation, most commonly occurring at the gastro-enteric anastomoses but sometimes at the entero-enteric anastomosis [1]. Endoscopic balloon dilation of stricture/stenosis has proven to be an effective, safe therapeutic tool [20]. The number of dilatations needed varies but is usually from one to four [21].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective 2-Year Follow-up of Late Complications Treated Surgically and Endoscopically After Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) for Morbid Obesity

et al. 2017

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“…The trainees could then be instructed in postoperative care of patients who have undergone bariatric surgery. Trainees could be trained in the management of adjustable gastric bands, postoperative nutritional disorders[ 52 ], postoperative symptoms and, as mentioned above, complications after Roux-en-Y gastric bypass surgery[ 3 ], and the management of major complications of vertical sleeve gastrectomy including gastric perforation or leak[ 53 ] and vomiting/dysphagia[ 54 ].…”

Section: Subspecialty Training Of Gastrointestinal Fellows In Bariatrmentioning

confidence: 99%

Organization of future training in bariatric gastroenterology

Koch

Shope

Gostout

2017

WJG

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A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the long-term impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a long-term approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees’ prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and costs, in individuals with medically-complicated obesity.

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Endoscopic Approach for Major Complications of Bariatric Surgery

Cited by 45 publications

References 98 publications

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

A Retrospective 2-Year Follow-up of Late Complications Treated Surgically and Endoscopically After Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) for Morbid Obesity

Organization of future training in bariatric gastroenterology

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