Endoscopic management of bariatric surgical complications

Vivek Kumbhari, Jennifer Xiaojin Cai, Michael A. Schweitzer*

*Corresponding author for this work

Research output: Contribution to journalReview article

10 Scopus citations

Abstract

Purpose of review Bariatric surgery is recognized as the most effective treatment against obesity as it results in significant weight reduction and a high rate of remission of obesity-related comorbidities. However, bariatric surgery is not uncommonly associated with complications and an endoscopic approach to management is preferred over surgical reintervention. This review illustrates the latest developments in the endoscopic management of bariatric surgical complications. Recent findings For successful management of complications, precipitating and perpetuating factors must be addressed in addition to directing therapy at the target pathology. Endoscopy is well tolerated even in the acute postoperative setting when performed carefully with CO2 insufflation. Chronic proximal staple-line leaks/ fistulas frequently do not respond to primary closure with diversion therapy, and a new technique of stricturotomy has been reported to improve outcomes. Innovations in the field of transoral endoscopic instruments have led to the development of a single-session entirely internal endoscopic retrograde cholangiopancreatography by creating a gastrogastric anastomosis. Summary Endoscopy allows for early diagnosis and prompt institution of therapy and should, therefore, be the firstline intervention in the management of complications of bariatric surgery in patients who do not need urgent surgical intervention. Computed tomography-guided drainage may be necessary in patients with drainable fluid collections.

Original languageEnglish (US)
Pages (from-to)359-367
Number of pages9
JournalCurrent Opinion in Gastroenterology
Volume31
Issue number5
DOIs
StatePublished - Aug 24 2015

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Keywords

  • Bariatric surgery
  • Laparoscopic sleeve gastrectomy
  • Roux-en-Y gastric bypass
  • Self-expandable metallic stent
  • Staple-line leak

ASJC Scopus subject areas

  • Gastroenterology

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