Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

Abstract

Background Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient. Methods A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb. Results Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total clousure of the fistula was reported 30 days afterward. Conclusions Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.

An innovative endoluminal rendezvous technique to restore gastrogastric continuity following extensive gastrointestinal loss from internal herniation after gastric bypass

“…A similar successful stenting approach was reported by Iqbal who also managed to bridge a 3 cm stenosis using EUS guidance and transillumination [7]. deMoura et al used a fully covered metal stent for transluminal reconnection after staple line failure from a gastric bypass [8].…”

Upper airway obstruction caused by bilateral giant tonsilloliths

“…X-ray of oral cavity shows radio-opaque shadow, but it is also easy to misjudge as foreign body, teeth, prominent mandibular ramus or maxilla, calcification in artery, lymph nodes, salivary gland, and styloid ligament. 4,5 The most convenient and accurate image is CT; through the characteristics of multi-slices and different views, we can accurately know the size, location of the tonsillolith, and surrounding inflammation. Although the diagnosis is relatively easy when CT is performed, the image studies are still not pathognomonic.…”

Endoscopic sleeve gastroplasty: From whence we came and where we are going

“…The most effective and durable treatment for obesity is bariatric and metabolic surgery[3-5]. However, disadvantages include the irreversible nature of the procedures and the non-negligible morbidity and mortality rates[6-14]. Furthermore, less than 2% of eligible patients who fulfill the criteria for bariatric surgery undergo the procedure.…”