Endoscopic Evaluation and Management of Late Complications After Bariatric Surgery: a Narrative Review

Overview

Journal Obes Surg

Date 2021 Jul 31

PMID 34331187

Citations 7

Authors

Vivek Kumbhari

Carel W le Roux

Ricardo V Cohen

Affiliations

Soon will be listed here.

Abstract

Despite ongoing evolution in technique and a low mortality rate, clinicians may care for patients who suffer late complications (> 90 days of surgery) after bariatric surgery. Endoscopic techniques are used to identify and manage many of the late complications of the two most commonly performed bariatric surgeries: sleeve gastrectomy and Roux-en-Y gastric bypass. Stenosis at the incisura angularis and gastroesophageal reflux disease may occur in patients who have undergone a sleeve gastrectomy. Patients who underwent a Roux-en-Y gastric bypass can suffer marginal ulceration, gastrojejunal anastomotic stricture, and gastro-gastric fistula. Clinicians may also encounter biliary pathologies such as choledocholithiasis, chronic abdominal pain, and weight regain. This narrative review provides an update on the endoscopic evaluation and management of patients with late complications after sleeve gastrectomy or Roux-en-Y gastric bypass.

Citing Articles

The Relevance of Gastroscopy in the Diagnostic Work-up for Marginal Ulceration in Patients Presenting with Abdominal Pain Following Laparoscopic Roux-en-Y Gastric Bypass.

van Hogezand L, Schropp L, Verdonk R, Wiezer M, Wijffels N, Takkenberg M Obes Surg. 2024; 35(1):40-46.

PMID: 39472342 DOI: 10.1007/s11695-024-07407-x.

Endoscopic approach for the management of a gastrogastric fistula, eroded band, and outlet stenosis after a vertical banded gastroplasty.

Ruiz-Cota P, Galvao M, Ortiz-Gomez E, Marquez-Gonzalez S, Principe J, Horgan S VideoGIE. 2024; 9(8):362-364.

PMID: 39233833 PMC: 11368684. DOI: 10.1016/j.vgie.2024.04.001.

Early Marginal Ulcer After Roux-en-Y Gastric Bypass: MBSAQIP Database Analysis of Trends and Predictive Factors.

Cornejo J, Evans L, Celik N, Elli E Obes Surg. 2024; 34(5):1536-1543.

PMID: 38502517 DOI: 10.1007/s11695-024-07179-4.

Endoscopic Management of Bleeding in Altered Anatomy after Upper Gastrointestinal Surgery.

Gibiino G, Binda C, Secco M, Giuffrida P, Coluccio C, Perini B Medicina (Kaunas). 2023; 59(11).

PMID: 38003990 PMC: 10672978. DOI: 10.3390/medicina59111941.

Weight loss maintenance after bariatric surgery.

Cho Y, Lee Y, Choi J, Lee S, Lee S World J Clin Cases. 2023; 11(18):4241-4250.

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References

Schauer P, Bhatt D, Kirwan J, Wolski K, Aminian A, Brethauer S . Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med. 2017; 376(7):641-651. PMC: 5451258. DOI: 10.1056/NEJMoa1600869. View

Madsbad S, Holst J . Bariatric surgery-which procedure is the optimal choice?. Lancet. 2019; 393(10178):1263-1264. DOI: 10.1016/S0140-6736(19)30489-1. View

Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G . Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015; 386(9997):964-73. DOI: 10.1016/S0140-6736(15)00075-6. View

Inge T, Courcoulas A, Jenkins T, Michalsky M, Brandt M, Xanthakos S . Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. N Engl J Med. 2019; 380(22):2136-2145. PMC: 7345847. DOI: 10.1056/NEJMoa1813909. View

Petrick A, Kuhn J, Parker D, Prasad J, Still C, Wood G . Bariatric surgery is safe and effective in Medicare patients regardless of age: an analysis of primary gastric bypass and sleeve gastrectomy outcomes. Surg Obes Relat Dis. 2019; 15(10):1704-1711. DOI: 10.1016/j.soard.2019.07.010. View

Feng X, Andalib A, Brethauer S, Schauer P, Aminian A . How safe is bariatric surgery in patients with class I obesity (body mass index 30-35 kg/m)?. Surg Obes Relat Dis. 2019; 15(2):253-260. DOI: 10.1016/j.soard.2018.12.006. View

Jackson W, Lewis S, Bagby J, Hilton L, Milad M, Bledsoe S . Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass in the pediatric population: a MBSAQIP analysis. Surg Obes Relat Dis. 2019; 16(2):254-260. DOI: 10.1016/j.soard.2019.11.009. View

Varban O, Bonham A, Finks J, Telem D, Obeid N, Ghaferi A . Is it worth it? Determining the health benefits of sleeve gastrectomy in patients with a body mass index <35 kg/m. Surg Obes Relat Dis. 2019; 16(2):248-253. DOI: 10.1016/j.soard.2019.10.027. View

Rebibo L, Maurice K, Nimier M, Ben Rehouma M, Montravers P, Msika S . Laparoscopic sleeve gastrectomy as day-case surgery: a review of the literature. Surg Obes Relat Dis. 2019; 15(7):1211-1217. DOI: 10.1016/j.soard.2019.03.020. View

10.

Aftab H, Fagerland M, Gondal G, Ghanima W, Olsen M, Nordby T . Gastric sleeve resection as day-case surgery: what affects the discharge time?. Surg Obes Relat Dis. 2019; 15(12):2018-2024. DOI: 10.1016/j.soard.2019.09.070. View

11.

Khorgami Z, Petrosky J, Andalib A, Aminian A, Schauer P, Brethauer S . Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery. Surg Obes Relat Dis. 2016; 13(2):273-280. DOI: 10.1016/j.soard.2016.01.034. View

12.

Acosta A, Streett S, Kroh M, Cheskin L, Saunders K, Kurian M . White Paper AGA: POWER - Practice Guide on Obesity and Weight Management, Education, and Resources. Clin Gastroenterol Hepatol. 2017; 15(5):631-649.e10. DOI: 10.1016/j.cgh.2016.10.023. View

13.

Fayad L, Schweitzer M, Raad M, Simsek C, Oleas R, Dunlap M . A Real-World, Insurance-Based Algorithm Using the Two-Fold Running Suture Technique for Transoral Outlet Reduction for Weight Regain and Dumping Syndrome After Roux-En-Y Gastric Bypass. Obes Surg. 2019; 29(7):2225-2232. DOI: 10.1007/s11695-019-03828-1. View

14.

Hourneaux de Moura D, de Moura E, Neto M, Jirapinyo P, Teixeira N, Orso I . Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study. Surg Obes Relat Dis. 2019; 15(8):1241-1251. DOI: 10.1016/j.soard.2019.05.022. View

15.

Dittrich L, Schwenninger M, Dittrich K, Pratschke J, Aigner F, Raakow J . Marginal ulcers after laparoscopic Roux-en-Y gastric bypass: analysis of the amount of daily and lifetime smoking on postoperative risk. Surg Obes Relat Dis. 2020; 16(3):389-396. DOI: 10.1016/j.soard.2019.11.022. View

16.

Yuce T, Khorfan R, Soper N, Hungness E, Nagle A, Teitelbaum E . Post-Operative Complications and Readmissions Associated with Smoking Following Bariatric Surgery. J Gastrointest Surg. 2019; 24(3):525-530. PMC: 7485607. DOI: 10.1007/s11605-019-04488-3. View

17.

Pyke O, Yang J, Cohn T, Yin D, Docimo S, Talamini M . Marginal ulcer continues to be a major source of morbidity over time following gastric bypass. Surg Endosc. 2018; 33(10):3451-3456. DOI: 10.1007/s00464-018-06618-5. View

18.

Spaniolas K, Yang J, Crowley S, Yin D, Docimo S, Bates A . Association of Long-term Anastomotic Ulceration After Roux-en-Y Gastric Bypass With Tobacco Smoking. JAMA Surg. 2018; 153(9):862-864. PMC: 6583878. DOI: 10.1001/jamasurg.2018.1616. View

19.

Ryou M, Mogabgab O, Lautz D, Thompson C . Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010; 6(5):526-31. DOI: 10.1016/j.soard.2010.02.035. View

20.

Bazarbashi A, McCarty T, Al-Obaid L, Skinner M, Thompson C . Efficacy and Safety of Novel, Disposable Endoscopic Scissors in Patients with Roux-en-Y Gastric Bypass: a Single-Center Feasibility Study. Obes Surg. 2019; 29(11):3749-3753. PMC: 6851485. DOI: 10.1007/s11695-019-04125-7. View