Endoscopic Management of Complications After Gastrointestinal Weight Loss Surgery

Kumar, Nitin; Thompson, Christopher C.

doi:10.1016/j.cgh.2012.10.043

Cited by 58 publications

(59 citation statements)

References 133 publications

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“…They may develop several months and even years after surgery, being most commonly caused by ulcers in gastrojejunoanastomosis or the remnant stomach and duodenum [1,4,6,7]. In late postoperative period about 20% of patients develop ulcers [8,9].…”

Section: Discussionmentioning

confidence: 99%

Bleeding after Gastric Bypass Surgery: The Possibility of using of Postoperative Balloon Enteroscopy

Mo¹,

As²,

Dv³

et al. 2017

J Gastrointest Dig Syst

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In the majority of cases late postoperative bleedings are intraluminal ones, showing clinical manifestations of high gastrointestinal hemorrhage. Among all bariatric procedures, this complication develops more commonly after Rouxen-Y gastric bypass. The most likely cause of such bleedings being peptic ulcer, conservative therapy with proton pump inhibitors is well justified at the initial stages of treatment. Upper endoscopy is the treatment of choice for bleeding ulcers localized in the pouch and 80% of bleedings in the pouch or gastroenteroanastomosis can be controlled in this way.If the bleeding is localized in the remnant stomach or duodenum and small intestine, more advanced endoscopic procedures are needed. Balloon enteroscopy is one of such techniques, although its efficacy in the treatment of bleeding resulting from biliopancreatic limb is extremely variable and depends mainly on specialist's skills, length of intestinal loop as well as severity of adhesions in the abdominal cavity. The article describes our experience of enteroscopy used to control bleeding from duodenal ulcer after Roux-en-Y gastric bypass intervention.

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Section: Discussionmentioning

confidence: 99%

Bleeding after Gastric Bypass Surgery: The Possibility of using of Postoperative Balloon Enteroscopy

Mo¹,

As²,

Dv³

et al. 2017

J Gastrointest Dig Syst

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“…In two systematic reviews, the incidence of leaks after laparoscopic sleeve gastrectomy was found to be 2.2% [3] to 2.4% [4] and the leaks are usually in the proximal third of the stomach near the gastroesophageal junction in 85%-89% [1,4] of cases, with an associated mortality rate of 6%-14.7% [1] . The use of enteric SEMSs has evolved from the management of malignant diseases to benign strictures as well as leaks.…”

Section: Discussionmentioning

confidence: 99%

“…Bariatric surgeries have been used as a modality to treat obesity, preferably after a multidisciplinary assessment. Although such an intervention has been proven to be effective in decreasing the excess weight of patients, it is associated with some complications of which surgical leaks are one of the most unfavorable with a considerable morbidity and mortality [1] . The management of staple line leaks post sleeve gastrectomy has evolved from surgical reinterventions to a less invasive approach with elimination of oral intake, parenteral nutrition, broad spectrum antimicrobial therapy, as well as percutaneous drainage procedures [1] .…”

Section: Introductionmentioning

confidence: 99%

“…The management of staple line leaks post sleeve gastrectomy has evolved from surgical reinterventions to a less invasive approach with elimination of oral intake, parenteral nutrition, broad spectrum antimicrobial therapy, as well as percutaneous drainage procedures [1] . More recently, the use of esophageal self-expandable metal stents (SEMS) or self-expandable plastic stents (SEPS) [1][2][3] as method of occluding these leaks has become a more acceptable form of management.…”

Section: Introductionmentioning

confidence: 99%

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Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

Almadi

Bamihriz

Aljebreen

2013

WJGS

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Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents (SEMS) in the management of the leak. Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwent a computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEMS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Stents; Esophagus; Leak; Surgery; Complication; Aortoesophageal fistula; Endoscopy; Bariatric surgery; Sleeve gastrectomy Core tip: One modality for managing staple line leaks after laparoscopic sleeve gastrectomies depends on a non-surgical approach, including elimination of oral intake, parenteral nutrition, use of broad spectrum antimicrobial therapy, drainage procedures and the use of esophageal self-expandable metal stents for sealing these leaks and the induction of tissue hyperplasia that would close these defects. Although this seems as a less invasive procedure when compared to a repeated surgical procedure and there is a body of evidence in the literature that supports such an approach, it is not void of complications. Here we report a fatal aortoesophageal fistula as a complication.Almadi MS, Bamihriz F, Aljebreen AM. Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy.

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“…При вы-полнении пилоросохраняющих модификаций БПШ частота язв не превышает 1% [39,40,45]. Основными факторами развития краевых язв являются оставление большой культи желудка, наличие диабета, курение, прием ацетилсалициловой кислоты и других нестероид-ных противовоспалительных препаратов [56,57,58].…”

Section: сахарный диабет Diabetes Mellitusunclassified

Evolution of biliopancreatic diversion in the treatment of morbid obesity and type 2 diabetes mellitus

et al. 2017

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The prevalence of morbid obesity is on the rise. Surgical intervention for the treatment of morbid obesity has been shown to provide high metabolic efficiency, acquiring a special role in the treatment of type 2 diabetes mellitus. Various surgical procedures are used in treating morbid obesity. These include gastric-bypass surgery and biliopancreatic bypass diversion (BPD), each with various advantages of its own. In recent years, BPD (also referred to as the Scopinaro procedure) has evolved and been modified into the single anastomosis duodeno-ileal (SADI) procedure. Like other types of BPD, the SADI procedure effectively reduces excess body weight and promotes normalisation of carbohydrate and lipid metabolism, leading to a reduced frequency of insulin therapy and use of antidiabetic drugs. The potential benefits of the procedure include reduced operative time and a reduced incidence of internal hernias. Studies have also shown that the SADI procedure results in fewer early and late post-operative complications. Given the effectiveness of the procedure, it is necessary to increase the number and duration of observations made to enable further insight into the long-term efficacy and use of the SADI procedure.

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Endoscopic Management of Complications After Gastrointestinal Weight Loss Surgery

Cited by 58 publications

References 133 publications

Bleeding after Gastric Bypass Surgery: The Possibility of using of Postoperative Balloon Enteroscopy

Bleeding after Gastric Bypass Surgery: The Possibility of using of Postoperative Balloon Enteroscopy

Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

Evolution of biliopancreatic diversion in the treatment of morbid obesity and type 2 diabetes mellitus

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