Endoscopic Management of Bariatric Surgery Complications

Abstract

Obesity is a global epidemic that has significant impact on morbidity, mortality, and rising health care costs. In morbidly obese patients with body mass index >40 kg/m2, bariatric surgery is a grade A recommendation and is associated with up to 40% reduction in premature death. Increasingly, endoscopy is seen as a safer and more cost-effective approach to the management of weight loss surgery complications including gastrointestinal bleeding, development of anastomotic ulcers, staple-line leaks and fistulas, strictures, weight regain, bezoars, choledocholithiasis, and gastric band erosion and slippage. Many endoscopic interventions currently rely on a combination of specialized equipment, such as stents, suture systems, clips, and balloon dilators to successfully treat these issues. This article will present common postoperative complications in bariatric surgery, discuss the latest evidence for their endoscopic management, and offer future directions in the endoluminal therapy of obese patients.

Endoscopic approach for the treatment of bariatric surgery complications

“…Acute or early gastrointestinal (GI) hemorrhage usually presents within the first hours to days after surgery and it is often secondary to technical error [2,3] . Its incidence is 1%-4% [9] .…”

“…Although bleeding usually occurs from the submucosal vessels along the staple line at the gastrojejunostomy, jejunojejunostomy, or the sleeve staple line, it can occur anywhere along the GI tract. Possible sites of bleeding include the gastric pouch and the gastric remnant, as well as extraluminal, at trocar insertion sites, dissection planes, or mesenteric or omental transection areas [2][3][4] . Late bleeding is usually caused by marginal ulceration or erosion (discussed below) [5,9] .…”

“…Obesity is a public health problem [1] . The number of bariatric procedures performed in the United States has increased significantly in the past decades [1,2] . Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common bariatric procedures performed [2,3] .…”

“…The number of bariatric procedures performed in the United States has increased significantly in the past decades [1,2] . Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common bariatric procedures performed [2,3] . The overall mortality rate of bariatric surgery is < 0.2%, yet the morbidity rate is between 4% and 10% with complications presenting most commonly within the first 30 days after surgery [2][3][4] .…”

“…Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common bariatric procedures performed [2,3] . The overall mortality rate of bariatric surgery is < 0.2%, yet the morbidity rate is between 4% and 10% with complications presenting most commonly within the first 30 days after surgery [2][3][4] . Some of the postoperative complications may be managed intraluminally using advances in surgical and interventional endoscopy [2][3][4][5][6] .…”