Endoscopic Evaluation and Management of Late Complications After Bariatric Surgery: a Narrative Review

Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

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Bariatric surgery and skeletal health: A narrative review and position statement for management by the European Calcified Tissue Society (ECTS)

Bone ◽

10.1016/j.bone.2021.116236 ◽

2021 ◽

pp. 116236

Author(s):

Julien Paccou ◽

Elena Tsourdi ◽

Christian Meier ◽

Andrea Palermo ◽

Jessica Pepe ◽

...

Keyword(s):

Bariatric Surgery ◽

Position Statement ◽

Narrative Review ◽

Skeletal Health ◽

Calcified Tissue

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Pregnancy as a cause of gastroesophageal reflux after mini-gastric bypass bariatric surgery (MGB-OAGB). A clinical case

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347.2018.12.2.076-079 ◽

2018 ◽

Vol 12 (2) ◽

pp. 76-79

Author(s):

V. S. Samoylov ◽

V. V. Novomlinskiy ◽

N. А. Malkina

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Gastroesophageal Reflux ◽

Clinical Symptoms ◽

Late Complications ◽

Mini Gastric Bypass ◽

Major Type ◽

Abdominal Pressure ◽

Complete Relief ◽

Bariatric Patients

The number of post-bariatric patients is increasing from year to year; any medical specialist can see consequences and sometimes complications of these interventions. The variety of different scenarios associated with such patients is not well studied. Mini-gastric bypass (MGB-OAGB) is a major type of primary or recurrent bariatric surgery in obese patients. Biliary reflux (BR) is one of the most significant late complications of this operation. An increase in the intra-abdominal pressure during pregnancy can lead to the development of BR with its typical clinical symptoms, which may sometimes puzzle an obstetrician-gynecologist. In these cases, there are limitations in using traditional diagnostic approaches and regular medications for conservative treatment of BR. This report presents a clinical observation on a patient who underwent MGB-OAGB as a recurrent bariatric intervention for her morbid obesity. With no signs of gastroesophageal reflux before surgery, soon after it or in the I trimester of pregnancy, a typical clinical picture of BR developed in the II and III trimesters. A complete relief of the BR symptoms after the childbirth (confirmed by gastro-esophago-scopy) suggested a direct connection between the BR and the increase in intra-abdominal pressure during pregnancy.

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Outcomes of Diabetic Microvascular Complications After Bariatric Surgery

Bariatric Surgical Practice Guide ◽

10.1007/978-981-10-2705-5_17 ◽

2017 ◽

pp. 137-144

Author(s):

Helen M. Heneghan ◽

Carel W. le Roux

Keyword(s):

Bariatric Surgery ◽

Microvascular Complications ◽

Complications After Bariatric Surgery ◽

Diabetic Microvascular Complications

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Endoscopic Management of Postbariatric Fistulae and Leaks

10.2310/gastro.5507 ◽

2015 ◽

Author(s):

Yana Cavanagh ◽

Sohail N. Shaikh

Keyword(s):

Bariatric Surgery ◽

Diagnostic Algorithm ◽

Therapeutic Endoscopy ◽

Late Complications ◽

Endoscopic Management ◽

High Morbidity ◽

Management Options ◽

Radiographic Findings ◽

Computed Tomographic ◽

American Society

The number of bariatric procedures performed annually is increasing along with the number of complications. Gastrointestinal leak after bariatric surgery generally portends high morbidity and mortality, and its management depends on clinical and radiographic presentation. A leak is defined as an enteric defect with extravasation of luminal contents. Fistulae are abnormal connections between two epithelialized surfaces, are usually chronic, and may develop from long-standing leaks. Endoscopic therapies may offer an attenuated risk profile compared with surgical intervention and play a growing role in the management of postbariatric complications. Leak resolution may require multiple endoscopic sessions and modalities (e.g., stents, adhesives, plugs, clips, suturing, and VAC-assisted closure); therefore, it is critical to have appropriate follow-up and surveillance after therapeutic endoscopic intervention. This review discusses endoscopic leak and fistula management through endoscopic procedures, addressing indications and candidates for procedure, contraindications, recipient evaluation, and aspects of procedure, including proper timing, equipment, and types. Figures show Roux-en-Y gastric bypass, sleeve gastrectomy, management options for leaks after bariatric surgery, a diagnostic algorithm for leaks, upper gastrointestinal series performed with Gastrografin, and computed tomographic scans that demonstrate extraluminal air extending along the diaphragmatic surface of the spleen and a perisplenic gas and fluid-filled collection on the lateral margin. Tables list complications that follow bariatric surgery; an excerpt from the 2008 American Society for Gastrointestinal Endoscopy Guidelines; recommended equipment for endoscopic defect management; classification system based on duration after bariatric surgery; classification and approach to management based on clinical presentation and radiographic findings; summary of recommendations for pre-endoscopy, index endoscopy, therapeutic endoscopy, and posttherapeutic endoscopy; and early and late complications of stent placement. This review contains 7 highly rendered figures, 7 tables, and 104 references.

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