Status of bariatric endoscopy–what does the surgeon need to know? A review

Abstract

BACKGROUND Obesity is a chronic and multifactorial disease with a variety of potential treatment options available. Currently, there are several multidisciplinary therapeutic options for its management, including conservative, endoscopic, and surgical treatment. AIM To clarify indications, technical aspects, and outcomes of bariatric endoscopy. METHODS Narrative review of current literature based on electronic databases including MEDLINE (PubMed), Cochrane Library, and SciELO. RESULTS Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical complications. Various devices act upon different mechanisms of action, which may be individualized to each patient. Despite favorable results for the endoscopic treatment of obesity, prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic therapies. Regarding the management of bariatric surgery complications, endoscopic therapy may be considered the procedure of choice in a variety of situations. Still, as there is no standardized algorithm, local experience should be considered in decision-making. CONCLUSION The treatment of patients with obesity is complex, and a multidisciplinary approach is essential. Bariatric endoscopy has shown impressive results both in the treatment of obesity and its surgical complications, and therefore, must be part of the armamentarium in the fight against this disease.

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

“…Different from several studies, 5,8,14,28 we reported the use of adjunctive endoscopic approaches in a substantial part of our population. This finding is related to our experience in treating these challenging conditions, as described in Methods 27,29–34 . It is important to state that there is no gold standard method to treat TGID.…”

“…To achieve clinical success, fundamental principles must be applied, such as adequate drainage and treatment of related factors. 1,2,19,23,26,27 For adequate drainage with EVT, the system needs to function. Compared to OPPS, the EVT is not effective when it is not possible to achieve negative pressure and should be considered a contraindication in some conditions such as tracheal-esophageal fistula, rectovaginal fistula, GI-cutaneous fistula, laparostomy, and pleurostomy Intolerance to the NGT followed by sepsis (1) Although rare, patient's intolerance to the tube can occur.…”

“…This finding is related to our experience in treating these challenging conditions, as described in Methods. 27,[29][30][31][32][33][34] It is important to state that there is no gold standard method to treat TGID. An individualized approach considering personal/local experience is required.…”

“…Furthermore, a multidisciplinary team is critical. 3,27,28 Although procedure time was not registered, the small H-EVT system allows for easy endoscopic insertion and removal, maneuverability, and positioning, reducing intraoperative time. These advantages are proven when comparing our results to studies using other EVT systems.…”

“…To achieve clinical success, fundamental principles must be applied, such as adequate drainage and treatment of related factors 1,2,19,23,26,27 . For adequate drainage with EVT, the system needs to function.…”