Obesity is a serious disorder in almost the entire world. It is an important risk factor for a series of conditions that affect and threaten health. Currently, bariatric surgery is the most effective treatment for morbid obesity, and in addition to the resulting weight loss, it reduces morbidity in this population. There has been a significant increase in the number of obese patients operated on. Despite the success of bariatric surgery, an important group of patients still present with major postoperative complications. In order for endoscopy to effectively contribute to the diagnosis and treatment of complications deriving from obesity surgery, the gastroenterologist must be aware of the particularities involved in bariatric surgery. The present article is a review of the resulting anatomic aspects of the main surgical techniques employed, the most common postoperative symptoms, the potential complications, and the possibilities that endoscopic diagnosis and treatment offer. Endoscopy is a growing and continuously evolving method in the treatment of bariatric surgery complications. The aim of this review is to contribute to the preparation of gastroenterologists so they can offer adequate endoscopic diagnosis and treatment to this high-risk population.
Endoscopic and histological correlation of the fi ndings of mucosa of the distal esophagus in nonerosive refl ux disease Abstract Background. Esophagogastroduodenoscopy (EGD) is frequently requested for patients with gastroesophageal refl ux symptoms. When the distal esophagus mucosa shows no erosions, questions are posed: (1) Does the esophageal biopsy contribute to confi rm refl ux as the cause of the symptoms? (2) Do minimum endoscopic changes have correspondence with histology? Methods. A total of 1901 patients were prospectively interviewed by a standard questionnaire to obtain a clinical diagnosis of gastroesophageal refl ux disease (GERD); 150 patients (98 males; median age, 42 years) with clinical manifestations of GERD and an intact esophageal mucosa were assigned to nonerosive refl ux disease (NERD) patients, and 49 patients (24 males; median age, 46 years) with no complaints of GERD were assigned to Controls. The EGD images were documented on tape. Four biopsies were performed at the distal esophagus. Experienced endoscopists and pathologists examined twice, at different times and separately, the respective endoscopic and histological examinations. For all comparisons, kappa (K) match, 95% confi dence interval, and the P value were determined. Results. In NERD patients, the match between endoscopic and histological fi ndings as to the aspect of the mucosa of the esophagus was poor (K = 0.08). EGD showed 17.2% sensitivity and 90.2% specifi city, whereas the esophagus histological study showed 39% sensitivity and 73% specifi city. NERD patients presented a greater frequency of esophagitis than Controls (38.6% vs. 22.4%), but this value was nonsignifi cant (P = 0.023). Conclusion. Agreement between patient symptoms or endoscopic fi ndings and histological diagnosis is poor; therefore, histology of the esophageal mucosa as a diagnostic test of NERD demonstrates low sensitivity and does not justify routine use.
Endoscopic clipping has become a common practice among endoscopists. Several models are available, most frequently being introduced via the working channel of the endoscope (through-the-scope); however, larger clips can also be mounted onto the distal tip of the endoscope (over-the-scope). The main indications for endoclip placement include providing effective mechanical hemostasis for bleeding lesions and allowing endoscopic closure of gastrointestinal perforations. Endoclips can also be used prophylactically after endoscopic resection; however, this practice is still controversial. This review discusses the main indications for endoscopic clipping in the esophagus, stomach, duodenum and colon to manage acute bleeding lesions, and the criteria to be used in the prevention of delayed post-polypectomy bleeding.
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