Endoscopic management of post-bariatric surgery complications

Abstract

Understanding the technical constructs of bariatric surgery is important to the treating endoscopist to maximize effective endoluminal therapy. Post-operative complication rates vary widely based on the complication of interest, and have been reported to be as high as 68% following adjustable gastric banding. Similarly, there is a wide range of presenting symptoms for post-operative bariatric complications, including abdominal pain, nausea and vomiting, dysphagia, gastrointestinal hemorrhage, and weight regain, all of which may provoke an endoscopic assessment. Bleeding and anastomotic leak are considered to be early (< 30 d) complications, whereas strictures, marginal ulcers, band erosions, and weight loss failure or weight recidivism are typically considered late (> 30 d) complications. Treatment of complications in the immediate post-operative period may require unique considerations. Endoluminal therapies serve as adjuncts to surgical and radiographic procedures. This review aims to summarize the spectrum and efficacy of endoscopic management of post-operative bariatric complications.

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] .…”

“…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] .…”

“…Complications can be divided into early (< 30 days) or late (> 30 days) [3,7] . Some can be encountered after any bariatric procedure and others are procedure specific [3] . The cornerstone for the diagnosis of luminal complications after weight loss surgery is esophagogastroduodenoscopy (EGD).…”

Laparoscopic adjustable gastric banding migration: an early approach for a late complication

“…Even if different approaches are shown in literature, endoscopic procedure in the post-bariatric follow-up is a valid possibility to diagnose and treat complications (1,3,9,12,13).…”