Flexible Endoscopy in the Management of Patients Undergoing Roux-en-Y Gastric Bypass

Schirmer, Bruce D.; Erenoglu, Cengiz; Miller, Abraham H.

doi:10.1381/096089202321019594

Cited by 218 publications

(100 citation statements)

References 6 publications

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“…In a study by Schirmer et al, out of 560 patients who underwent Roux-en-Y gastric bypass at a single institution, 4.9% (26 patients) had endoscopic findings that changed or altered the operative procedure. 12 These findings included esophagitis, gastroduodenal ulcers, hiatal hernia, and gastric polyps, all findings that did not lead to cancellation of any procedure. 12 Similarly, in a study by Sharaf et al, in a cohort of 195 patients who underwent EGD prior to bariatric surgery, 42 patients had clinically important findings that ultimately resulted in either alteration of the surgical procedure (e.g., reduction of hiatal hernia) or medical management prior to operation.…”

Section: Discussionmentioning

confidence: 98%

“…12 These findings included esophagitis, gastroduodenal ulcers, hiatal hernia, and gastric polyps, all findings that did not lead to cancellation of any procedure. 12 Similarly, in a study by Sharaf et al, in a cohort of 195 patients who underwent EGD prior to bariatric surgery, 42 patients had clinically important findings that ultimately resulted in either alteration of the surgical procedure (e.g., reduction of hiatal hernia) or medical management prior to operation. 13 Similar findings were demonstrated in a study by Loewen et al, in which, out of 451 consecutively screened patients undergoing preoperative EGD, positive findings that lead to a change in medical management were seen in 18% of the cohort, but no patients had bariatric surgery cancelled.…”

Section: Discussionmentioning

confidence: 98%

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Routine Screening Endoscopy before Bariatric Surgery: Is It Necessary?

Gómez

Bhalla

Heckman

et al. 2014

Bariatric Surgical Practice and Patient Care

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Background: Routine esophagogastroduodenoscopy (EGD) prior to bariatric surgery has not been consistently shown to change the management of the patient. A study was performed to estimate the proportion of patients undergoing bariatric surgery evaluation who had abnormal findings on preoperative EGD that resulted in alteration of management and, second, to evaluate potential risk factors for occurrence of abnormal findings on the EGD. Methods: An observational, retrospective study in which all 232 patients who were cleared to undergo bariatric surgery and who underwent preoperative EGD between 2006 and 2013 were included at a single tertiary dedicated bariatric center for weight loss management. Abnormal findings on screening EGD and medical or surgical management alteration based on the EGD findings were reviewed. Results: Abnormal findings on screening EGD were found in 143 patients (61.6%). Thirty-five patients had medical management altered (15.1%), while four patients (1.7%) had surgical management altered. Being aged > 55 years and the presence of gastroesophageal reflux disease were associated with occurrence of an abnormal finding on screening EGD. Conclusions: While abnormalities on preoperative EGD are often found in patients undergoing bariatric surgery evaluation, rarely do the findings change surgical management. Alternative methods for screening for common GI conditions should be considered in appropriate patients.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Routine Screening Endoscopy before Bariatric Surgery: Is It Necessary?

Gómez

Bhalla

Heckman

et al. 2014

Bariatric Surgical Practice and Patient Care

View full text Add to dashboard Cite

show abstract

“…Serial dilatations may be required for late strictures where there is a well-established fibrotic response. 12,20 Perforation remains a real risk (incidence of up to 2.1%), 9 particularly within 4 weeks of operation. Endoscopy should ideally be performed in the specialist bariatric unit and supportive initial management is all that is required from the emergency on-call surgeon.…”

Section: Anastomotic Stricturementioning

confidence: 99%

“…In one series, 20% of CT scans were reported as normal in patients who subsequently underwent surgery for incarcerated internal hernias. 20 The serum amylase level may be raised due to obstruction of the biliopancreatic limb which may result in the misdiagnosis of pancreatitis. 2 The on-call surgeon should operate if signs of intestinal necrosis are present (pain, acidosis, lactate rise).…”

Section: Internal Herniasmentioning

confidence: 99%

Complications of Bariatric Surgery: Presentation and Emergency Management – a Review

Monkhouse

Morgan

Norton

2009

annals

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Ann R Coll Surg Engl 2009; 91: 280-286 280Obesity is a world-wide epidemic 1 and is associated with multiple serious co-morbidities, both physical and psychological. Over the last decade, there has been an exponential rise in the number of bariatric procedures being offered, 2 as these have consistently been shown to be the only way to achieve sustainable weight loss and improvement in comorbidities, particularly type II diabetes and hypertension. There are many different surgical operations available to achieve weight loss; the choice of surgery depends on a number of factors, not least the experience of the surgeon and the patient's individual requirements. The predominant operation performed in the UK is the laparoscopic adjustable gastric band (LAGB), which is a purely restrictive procedure. Other procedures incorporate a malabsorptive element and include the Roux-en-Y gastric bypass (RYGB) and the biliopancreatic diversion (with or without duodenal switch; BPD, BPD/DS; Fig. 1A). Other operations include sleeve gastrectomy (Fig. 1B) which can be used as a definitive procedure or as a bridge to further by-pass surgery, and the largely historic vertical banded gastroplasty. All surgery carries some degree of risk and the decision to operate is made after a careful balance of the risks versus the benefits. This particular group of patients often have limited physiological reserves and this, together with their physical size, may make the surgery high-risk. Early detection and appropriate management of complications is crucial to prevent long-term morbidity and mortality.This review highlights the main complications that the general surgeon on-call may encounter as an emergency and illustrates the appropriate management strategies.A full literature search was carried out using PubMED and the Cochrane Library. Relevant international articles published in the last 10 years were assessed. Keywords for search purposes included bariatric, surgery, complications, emergency and management. Band-related complications Dysphagia/band slippageImmediate postoperative dysphagia is seen in some patients following LAGB. This is usually due to excessive perigastric fat resulting in a tightly fitting band or to postoperative oedema. Complete dysphagia, even for saliva, may take up to 10 days to resolve. Postoperative intravenous steroids and a strict nil-by-mouth regimen appear to increase the resolution rate for the oedema and thus hasten recovery. These patients are often in-patients until postoperative dysphagia resolves and so it is late dysphagia that more commonly The prevalence of obesity surgery is increasing rapidly in the UK as demand rises. Consequently, general surgeons on-call may be faced with the complications of such surgery and need to have an understanding about how to manage them, at least initially. Obesity surgery is mainly offered in tertiary centres but patients may present with problems to their local district hospital. This review summarises the main complications that may be encountered. MATERIALS AND M...

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“…In this series, the most common finding was hiatal hernia (40%) that required crural repair or reduction of the hernia. Schirmer et al [86], in another retrospective study, reported that the incidence of postoperative marginal ulcers was significantly lower in the group of patients who were preoperatively tested for the presence of H. pylori and treated if positive, as compared to those in whom no preoperative testing was performed (2.4% as compared to 6.9%, p < 0.05).…”

Section: Types Of Surgical Proceduresmentioning

confidence: 99%

Surgery for Obesity: Panacea or Pandora’s Box?

2006

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Background: Given the increasing prevalence of obesity, healthcare providers should be cognizant of various non-operative (diet, exercise, behavior therapy, and medications) and operative obesity treatments. This review critically evaluates these treatments, especially bariatric surgeries. Methods: Medline analyses using a combination of the following terms: obesity, bariatric surgery, and outcomes were performed with particular emphasis on prospective studies and randomized trials. Results: Non-operative treatments result in modest sustained weight loss (5–8%) at one year. Surgery is recommended for those with BMI >40 or >35 with comorbidities. Laparoscopic adjustable gastric banding, a restrictive procedure, causes 35–54% excess weight loss (EWL) at 1 year. Malabsorptive procedures (biliopancreatic diversions with and without duodenal switch) induce 72–77% EWL but are only performed at few centers. Roux-en-Y gastric bypass, acting through a combination of restriction and malabsorption, results in 69% EWL at 1 year and 49% at 14 years. Each procedure is associated with unique anatomic and nutritional complications. Overall, operative treatment improves comorbidities and may improve all-cause mortality. Conclusions: Surgery is an effective long-term treatment for selected obese patients who have failed other treatments. Further research is needed on prospective comparisons of procedures, evaluation of long-term outcomes, especially between centers and increasingly unrealistic patient expectations.

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Flexible Endoscopy in the Management of Patients Undergoing Roux-en-Y Gastric Bypass

Abstract: Upper endoscopy is a tool which may be used by the surgeon in the preoperative and postoperative management of patients undergoing RYGBP to modify therapy, improve outcomes, and diagnose and treat postoperative complications.

Cited by 218 publications

References 6 publications

Routine Screening Endoscopy before Bariatric Surgery: Is It Necessary?

Routine Screening Endoscopy before Bariatric Surgery: Is It Necessary?

Complications of Bariatric Surgery: Presentation and Emergency Management – a Review

Surgery for Obesity: Panacea or Pandora’s Box?

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