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Current Treatment Options in Gastroenterology

Published in:

01-12-2017 | Stomach (DA Johnson, Section Editor)

Endoscopic Evaluation/Management of Bariatric Surgery Complications

Authors: Allison R. Schulman, MD, MPH, Christopher C. Thompson, MD, MSc, FASGE, FACG AGAF

Published in: Current Treatment Options in Gastroenterology | Issue 4/2017

Opinion Statement

Purpose of Review Bariatric surgery has become increasingly common given the increasing prevalence of obesity and its associated co-morbidities. As a result, patients who have surgically altered anatomy will be seen with increasing frequency by gastroenterologists.

Recent Findings Complications that arise in this patient population are unique and require specific knowledge for appropriate treatment.

Summary A basic understanding of surgical anatomy, possible complications, and endoscopic techniques for management is crucial. This review focus on major complications that arise in the setting of bariatric surgery and commonly seen by endoscopists.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef

Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival [Internet]. JAMA. 2015;313:62.PubMedCrossRef

Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. [Internet]. Obes Surg. 2013;23:427–36.PubMedCrossRef

Perry CD, Hutter MM, Smith DB, et al. Survival and changes in comorbidities after bariatric surgery. [Internet]. Ann Surg. 2008;247:21–7.PubMedCrossRef

Colquitt JL, Clegg AJ, Loveman E, et al. Surgery for morbid obesity [Internet]. In: Colquitt JL, editor. Cochrane database of systematic reviews. Chichester: John Wiley & Sons, Ltd; 2005. p. CD003641. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16235331.

Azagury DE, Abu Dayyeh BK, Greenwalt IT, et al. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 2011;43:950–4.PubMedCrossRef

Dallal RM, Bailey LA. Ulcer disease after gastric bypass surgery [Internet]. Surg Obes Relat Dis. 2006;2:455–9. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16925380 PubMedCrossRef

Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. [Internet]. Surg Endosc. 2007;21:1090–4. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s00464-007-9285-x PubMedCrossRef

Coblijn UK, Lagarde SM, de Castro SMM, et al. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. [Internet]. Obes Surg. 2015;25:805–11. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s11695-014-1482-9 PubMedCrossRef

10.

Edholm D, Sundbom M. Comparison between circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass—a cohort from the Scandinavian Obesity Registry [Internet]. Surg Obes Relat Dis. 2015;11:1233–6. [cited 2017 Apr 21] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25979205 PubMedCrossRef

11.

Sacks BC, Mattar SG, Qureshi FG, et al. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass [Internet]. Surg Obes Relat Dis. 2006;2:11–6. [cited 2017 Apr 21] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16925306 PubMedCrossRef

12.

Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. [Internet]. Obes Surg. 2002;12:634–8. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1381/096089202321019594 PubMedCrossRef

13.

Cleator IG, Rae A, Birmingham CL. Ulcerogenesis following gastric procedure for obesity. [Internet]. Obes Surg. 1996;6:260–1. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10729870 PubMedCrossRef

14.

Papasavas PK, Gagné DJ, Donnelly PE, et al. Prevalence of Helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic Roux-en-Y gastric bypass [Internet]. Surg Obes Relat Dis. 2008;4:383–8. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17974495 PubMedCrossRef

15.

Lin Y-S, Chen M-J, Shih S-C, et al. Management of Helicobacter pylori infection after gastric surgery [Internet]. World J Gastroenterol. 2014;20:5274. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24833857 PubMedPubMedCentralCrossRef

16.

Hartin CW, ReMine DS, Lucktong TA. Preoperative bariatric screening and treatment of helicobacter pylori. [Internet]. Surg Endosc. 2009;23:2531–4. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s00464-009-0449-8 PubMedCrossRef

17.

Rawlins L, Rawlins MP, Brown CC, et al. Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. [Internet]. Surg Obes Relat Dis. 2013;9:760–4. [cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1550728912002493 PubMedCrossRef

18.

Schulman AR, Abougergi M, Thompson CC. H. Pylori as a predictor of marginal ulceration: a nationwide analysis. Obesity. 2017;25(3):522–6. https://doi.org/10.1002/oby.21759.PubMedCrossRef

19.

• Schulman AR, Chan WW, Devery A, et al. Opened proton pump inhibitor capsules reduce time to healing compared with intact capsules for marginal ulceration following roux-en-Y gastric bypass [Internet]. Clin Gastroenterol Hepatol. 2016;14(6):809–815.e1. https://doi.org/10.1016/j.cgh.2015.10.022. Important clinical tip for accelerating healing.CrossRef

20.

Ryou M, Mogabgab O, Lautz DB, et al. Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass [Internet]. Surg Obes Relat Dis. 2010;6:526–31. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20870185 PubMedCrossRef

21.

Jirapinyo P, Watson RR, Thompson CC. Use of a novel endoscopic suturing device to treat recalcitrant marginal ulceration (with video). [Internet]. Gastrointest Endosc. 2012;76:435–9. [cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S0016510712009662 PubMedCrossRef

22.

Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass [Internet]. Surg Obes Relat Dis. 2009;5:317–22. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19136312 PubMedCrossRef

23.

Schneider BE, Villegas L, Blackburn GL, et al. Laparoscopic gastric bypass surgery: outcomes [Internet]. J Laparoendosc Adv Surg Tech. 2003;13:247–55. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14561253 CrossRef

24.

Awad S, Aguilo R, Agrawal S, et al. Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypass [Internet]. Surg Endosc. 2015;29:2278–83. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25380709 PubMedCrossRef

25.

Sanyal AJ, Sugerman HJ, Kellum JM, et al. Stomal complications of gastric bypass: incidence and outcome of therapy. [Internet]. Am J Gastroenterol. 1992;87:1165–9. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1519574 PubMed

26.

Ahmad J, Martin J, Ikramuddin S, et al. Endoscopic balloon dilation of gastroenteric anastomotic stricture after laparoscopic gastric bypass. [Internet]. Endoscopy. 2003;35:725–8. [cited 2017 Jan 14] Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-2003-41579 PubMedCrossRef

27.

Peifer KJ, Shiels AJ, Azar R, et al. Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. [Internet]. Gastrointest Endosc. 2007;66:248–52. [cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S0016510706031154 PubMedCrossRef

28.

Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. [Internet]. J Gastrointest Surg. 2003;7:997–1003. discussion 1003.[cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14675709 PubMedCrossRef

29.

Huang CS. The role of the endoscopist in a multidisciplinary obesity center. [Internet]. Gastrointest Endosc. 2009;70:763–7. [cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S0016510709000406 PubMedCrossRef

30.

Barba CA, Butensky MS, Lorenzo M, et al. Endoscopic dilation of gastroesophageal anastomosis stricture after gastric bypass. [Internet]. Surg Endosc. 2003;17:416–20. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s00464-002-8908-5 PubMedCrossRef

31.

Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. [Internet]. Arch Surg. 2003;138:957–61. [cited 2017 Jan 14] Available from: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.138.9.957 PubMedCrossRef

32.

Gould JC, Garren M, Boll V, et al. The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. [Internet]. Surg Endosc. 2006;20:1017–20. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s00464-005-0207-5 PubMedCrossRef

33.

Fisher BL, Atkinson JD, Cottam D. Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study [Internet]. Surg Obes Relat Dis. 2007;3:176–9. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17331806 PubMedCrossRef

34.

Giordano S, Salminen P, Biancari F, et al. Linear stapler technique may be safer than circular in gastrojejunal anastomosis for laparoscopic Roux-en-Y gastric bypass: a meta-analysis of comparative studies [Internet]. Obes Surg. 2011;21:1958–64. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s11695-011-0520-0 PubMedCrossRef

35.

Go MR, Muscarella P, Needleman BJ, et al. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. [Internet]. Surg Endosc. 2004;18:56–9. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s00464-003-8919-x PubMedCrossRef

36.

Majumder S, Buttar N, Gostout C, et al. Lumen-apposing covered self-expanding metal stent for management of benign gastrointestinal strictures [Internet]. Endosc Int Open. 2015;4:E96–E101. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/26793793 PubMedPubMedCentralCrossRef

37.

•• Uchima H, Abu-Suboh M, Mata A, et al. Lumen-apposing metal stent for the treatment of refractory gastrojejunal anastomotic stricture after laparoscopic gastric bypass [Internet]. Gastrointest Endosc. 2016;83:251.[cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/26255145. New technologic advance for treatment of this complication

38.

Lee JK, Van Dam J, Morton JM, et al. Endoscopy is accurate, safe, and effective in the assessment and management of complications following gastric bypass surgery. [Internet]. Am J Gastroenterol. 2009;104:575–82. quiz 583.[cited 2017 Jan 14] Available from: http://www.nature.com/doifinder/10.1038/ajg.2008.102 PubMedCrossRef

39.

Campos JM, De Mello FST, Ferraz AAB, et al. Endoscopic dilation of gastrojejunal anastomosis after gastric bypass. [Internet]. Arq Bras Cir Dig. 2012;25:283–9. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23411930 PubMedCrossRef

40.

Tucker ON, Szomstein S, Rosenthal RJ. Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity [Internet]. J Gastrointest Surg. 2007;11:1673–9. [cited 2017 Jan 16] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17912592 PubMedCrossRef

41.

•• Pauli EM, Beshir H, Mathew A. Gastrogastric fistulae following gastric bypass surgery—clinical recognition and treatment [Internet]. Curr Gastroenterol Rep. 2014;16(9):405. https://doi.org/10.1007/s11894-014-0405-1. Excellent description of endoscopic managementPubMedCrossRef

42.

Stanczyk M, Deveney C, Traxler S, et al. Gastro-gastric fistula in the era of divided Roux-en-Y gastric bypass: strategies for prevention, diagnosis, and management [Internet]. Obes Surg. 2006;16:359–64. [cited 2017 Jan 16] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16545169 PubMedCrossRef

43.

Huang CS, Forse RA, Jacobson BC, et al. Endoscopic findings and their clinical correlations in patients with symptoms after gastric bypass surgery. [Internet]. Gastrointest Endosc. 2003;58:859–66. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14652553 PubMedCrossRef

44.

Mukewar S, Kumar N, Catalano M, et al. Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study [Internet]. Endoscopy. 2016;48:1023–8. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27576179 PubMedCrossRef

45.

Fernandez-Esparrach G, Lautz DB, Thompson CC. Endoscopic repair of gastrogastric fistula after roux-en-Y gastric bypass: a less-invasive approach [Internet]. Surg Obes Relat Dis. 2010;6:282–8. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20510291 PubMedCrossRef

46.

•• Haito-Chavez Y, Law JK, Kratt T, et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). [Internet]. Gastrointest Endosc. 2014;80:610–22. [cited 2017 Jan 15] Available from: http://linkinghub.elsevier.com/retrieve/pii/S0016510714013340. Excellent report highlighting technique and with video examples.

47.

Niland B, Brock A. Over-the-scope clip for endoscopic closure of gastrogastric fistulae [Internet]. Surg Obes Relat Dis. 2016;[cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27693362

48.

Flicker MS, Lautz DB, Thompson CC. Endoscopic management of gastrogastric fistulae does not increase complications at bariatric revision surgery [Internet]. J Gastrointest Surg. 2011;15:1736–42. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21479671 PubMedCrossRef

49.

Law R, Wong Kee Song LM, Irani S, et al. Immediate technical and delayed clinical outcome of fistula closure using an over-the-scope clip device. [Internet]. Surg Endosc. 2015;29:1781–6. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1007/s00464-014-3860-8 PubMedCrossRef

50.

Nelson DW, Blair KS, Martin MJ. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. [Internet]. Arch Surg. 2012;147:847–54. [cited 2017 Jan 14] Available from: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.2012.1654 PubMedCrossRef

51.

Gonzalez R, Nelson LG, Gallagher SF, et al. Anastomotic leaks after laparoscopic gastric bypass [Internet]. Obes Surg. 2004;14:1299–307. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15603642 PubMedCrossRef

52.

Almahmeed T, Gonzalez R, Nelson LG, et al. Morbidity of anastomotic leaks in patients undergoing Roux-en-Y gastric bypass [Internet]. Arch Surg. 2007;142:–954. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17938308

53.

Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75:287–93.PubMedCrossRef

54.

Mickevicius A, Sufi P, Heath D. Factors predicting the occurrence of a gastrojejunal anastomosis leak following gastric bypass [Internet]. Videosurgery Other Miniinvasive Tech. 2014;3:436–40. [cited 2017 Jan 16] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25337170 CrossRef

55.

Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks [Internet]. Surg Obes Relat Dis. 2006;2:570–2. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17015217 PubMedCrossRef

56.

Fukumoto R, Orlina J, McGinty J, et al. Use of Polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. [Internet]. Surg Obes Relat Dis. 2007;3:68–71. 2.[cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1550728906008987 PubMedCrossRef

57.

Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. [Internet]. Endoscopy. 2007;39:625–30. [cited 2017 Jan 14] Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-2007-966533 PubMedCrossRef

58.

Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. [Internet]. Obes Surg. 2007;17:866–72. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17894143 PubMedCrossRef

59.

Casella G, Soricelli E, Rizzello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy [Internet]. Obes Surg. 2009;19:821–6. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19381737 PubMedCrossRef

60.

Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. [Internet]. J Am Coll Surg. 2008;206:935–8. 9.[cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1072751508002160 PubMedCrossRef

61.

Babor R, Talbot M, Tyndal A. Treatment of upper gastrointestinal leaks with a removable, covered, self-expanding metallic stent [Internet]. Surg Laparosc Endosc Percutan Tech. 2009;19:e1–4. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19238047 PubMedCrossRef

62.

Edwards CA, Bui TP, Astudillo JA, et al. Management of anastomotic leaks after Roux-en-Y bypass using self-expanding polyester stents. [Internet]. Surg Obes Relat Dis. 2008;4:594–9-600. [cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1550728908005236 PubMedCrossRef

63.

Merrifield BF, Lautz D, Thompson CC. Endoscopic repair of gastric leaks after Roux-en-Y gastric bypass: a less invasive approach. [Internet]. Gastrointest Endosc. 2006;63:710–4. [cited 2017 Jan 14] Available from: http://linkinghub.elsevier.com/retrieve/pii/S001651070503302X PubMedCrossRef

64.

Kriwanek S, Ott N, Ali-Abdullah S, et al. Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents. [Internet]. Obes Surg. 2006;16:1669–74. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1381/096089206779319365 PubMedCrossRef

65.

Ballesta C, Berindoague R, Cabrera M, et al. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. [Internet]. Obes Surg. 2008;18:623–30. [cited 2017 Jan 14] Available from: http://link.springer.com/10.1007/s11695-007-9297-6 PubMedCrossRef

66.

•• Thompson CC, Kumar N, Slattery J, et al. A standardized method for endoscopic necrosectomy improves complication and mortality rates. [Internet]. Pancreatology. 2016;16:66–72. [cited 2017 Mar 31] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1424390315007152. cite as 3 dots—Important report highlighting standardization and management

67.

•• Kumar N, Conwell DL, Thompson CC. Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization. [Internet]. Pancreas. 2014;43:1334–9. [cited 2017 Mar 31] Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006676-201411000-00033. Emerging endoscopic approach with excellent focus on outcomes.

68.

Jacobsen GR, Coker AM, Acosta G, et al. Initial experience with an innovative endoscopic clipping system. [Internet]. Surg Technol Int. 2012;22:39–43. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23225590 PubMed

69.

Ritter LA, Wang AY, Sauer BG, et al. Healing of complicated gastric leaks in bariatric patients using endoscopic clips [Internet]. JSLS J Soc Laparoendosc Surg. 2013;17:481–3. [cited 2017 Jan 14] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24018092 CrossRef

70.

Seebach L, Bauerfeind P, Gubler C. “Sparing the surgeon”: clinical experience with over-the-scope clips for gastrointestinal perforation. [Internet]. Endoscopy. 2010;42:1108–11. [cited 2017 Jan 14] Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0030-1255924 PubMedCrossRef

71.

Shiffman ML, Sugerman HJ, Kellum JM, et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. [Internet]. Am J Gastroenterol. 1991;86:1000–5. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1858735 PubMed

72.

Shiffman ML, Sugerman HJ, Kellum JM, et al. Changes in gallbladder bile composition following gallstone formation and weight reduction. [Internet]. Gastroenterology. 1992;103:214–21. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1612328 PubMedCrossRef

73.

Worobetz LJ, Inglis FG, Shaffer EA. The effect of ursodeoxycholic acid therapy on gallstone formation in the morbidly obese during rapid weight loss. [Internet]. Am J Gastroenterol. 1993;88:1705–10. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8213711 PubMed

74.

de Oliveira Iglézias Brandão C, Adami Chaim E, da Silva BB, et al. Obes Surg. 2003;13:625–8. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1381/096089203322190862 CrossRef

75.

Bastouly M, Arasaki CH, Ferreira JB, et al. Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones. [Internet]. Obes Surg. 2009;19:22–8. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1007/s11695-008-9648-y PubMedCrossRef

76.

Everhart JE. Contributions of obesity and weight loss to gallstone disease. [Internet]. Ann Intern Med. 1993;119:1029–35. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8214980 PubMedCrossRef

77.

Inamdar S, Slattery E, Sejpal DV, et al. Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy. Gastrointest Endosc. 2015;82:9–19.PubMedCrossRef

78.

•• Thompson CC, Ryou MK, Kumar N, et al. Single-session EUS-guided transgastric ERCP in the gastric bypass patient [Internet]. Gastrointest Endosc. 2014;80:517. [cited 2017 Jan 27] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25028276. Provides new information on single session.

79.

Kedia P, Kumta N, Widmer J, et al. Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: a novel technique [Internet]. Endoscopy. 2015;47:159–63. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25575353 PubMedCrossRef

80.

Tyberg A, Nieto J, Salgado S, et al. Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography or EUS: mid-term analysis of an emerging procedure [Internet]. Clin. Endosc. 2016;[cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27642849

81.

Monaco-Ferreira DV, Leandro-Merhi VA. Weight regain 10 years after Roux-en-Y gastric bypass [Internet]. Obes. Surg. 2016;[cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27798793.

82.

Nicoletti CF, de Oliveira BAP, De Pinhel MAS, et al. Influence of excess weight loss and weight regain on biochemical indicators during a 4-year follow-up after roux-en-Y gastric bypass [Internet]. Obes Surg. 2015;25:279–84. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24996801 PubMedCrossRef

83.

Christou NV, Look D, MacLean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years [Internet]. Ann Surg. 2006;244:734–40. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17060766 PubMedPubMedCentralCrossRef

84.

Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study [Internet]. Obes Surg. 2008;18:648–51. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18392907 PubMedCrossRef

85.

Barhouch AS, Padoin AV, Casagrande DS, et al. Predictors of excess weight loss in obese patients after gastric bypass: a 60-month follow-up [Internet]. Obes Surg. 2016;26:1178–85. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/26433591 PubMedCrossRef

86.

Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after roux-en-Y gastric bypass [Internet]. Clin Gastroenterol Hepatol. 2011;9:228–33. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21092760 PubMedCrossRef

87.

Baretta GAP, Alhinho HCAW, Matias JEF, et al. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass [Internet]. Obes Surg. 2015;25:72–9. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25005812 PubMedCrossRef

88.

Abu Dayyeh BK, Jirapinyo P, Weitzner Z, et al. Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures. [Internet]. Gastrointest Endosc. 2012;76:275–82. [cited 2017 Jan 15] Available from: http://linkinghub.elsevier.com/retrieve/pii/S0016510712016963 PubMedPubMedCentralCrossRef

89.

Thompson CC, Slattery J, Bundga ME, et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. [Internet]. Surg Endosc. 2006;20:1744–8. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1007/s00464-006-0045-0 PubMedCrossRef

90.

Mullady DK, Lautz DB, Thompson CC. Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). [Internet]. Gastrointest Endosc. 2009;70:440–4. [cited 2017 Jan 15] Available from: http://linkinghub.elsevier.com/retrieve/pii/S001651070900251X PubMedCrossRef

91.

Jirapinyo P, Slattery J, Ryan MB, et al. Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following roux-en-Y gastric bypass. [Internet]. Endoscopy. 2013;45:532–6. [cited 2017 Jan 15] Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0032-1326638 PubMedCrossRef

92.

Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up [Internet]. Gastrointest Endosc. 2016;83:776–9. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/26344204 PubMedCrossRef

93.

Fernández-Esparrach G, Lautz DB, Thompson CC. Peroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients [Internet]. Surg Obes Relat Dis. 2010;6:36–40. [cited 2017 Feb 22] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19560979 PubMedCrossRef

94.

Swanson CM, Roust LR, Miller K, et al. What every hospitalist should know about the post-bariatric surgery patient. [Internet]. J Hosp Med. 2012;7:156–63. [cited 2017 Jan 15] Available from: http://doi.wiley.com/10.1002/jhm.939 PubMedCrossRef

95.

Carucci LR, Turner MA. Imaging after bariatric surgery for morbid obesity: roux-en-Y gastric bypass and laparoscopic adjustable gastric banding [Internet]. Semin Roentgenol. 2009;44:283–96. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19715793 PubMedCrossRef

96.

Schulman AR, Thompson CC. Utility of bile acid scintigraphy in the diagnosis of remnant gastropathy in patients with Roux-en-Y gastric bypass [Internet]. Obes. Surg. 2017;[cited 2017 Aug 28] Available from: http://www.ncbi.nlm.nih.gov/pubmed/28766266

97.

Kumar N, Thompson CC. Ursodiol is effective for treatment of abdominal pain associated with gastritis of the remnant stomach in Roux-en-Y gastric bypass patients. Gastroenterology. 2013;144:S-270.CrossRef

98.

Ramón JM, Salvans S, Crous X, et al. Effect of roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial [Internet]. J Gastrointest Surg. 2012;16:1116–22. [cited 2017 Mar 31] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22402955 PubMedCrossRef

99.

Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial [Internet]. Obes Surg. 2012;22:740–8. [cited 2017 Mar 31] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22354457 PubMedPubMedCentralCrossRef

100.

Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity [Internet]. Surg Endosc. 2006;20:859–63. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16738970 PubMedCrossRef

101.

Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. [Internet]. Surg Obes Relat Dis. 2008;4:33–8. [cited 2017 Jan 15] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1550728907005928 PubMedCrossRef

102.

•• Abidi W, Thompson CC. Systematic treatment of sleeve gastrectomy stenosis with hydrostatic and pneumatic balloon dilatation is safe and effective. Gastroenterology. 2016;150:S828–9. Discussess efficacy and safety for complications of every increasing bariatric procedureCrossRef

103.

Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity [Internet]. Obes Surg. 2009;19:1672–7. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19506979 PubMedCrossRef

104.

Mahadev S, Kumbhari V, Campos JM, et al. Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections. [Internet]. Endoscopy 2017;[cited 2017 Feb 22] Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-122012

105.

Baretta G, Campos J, Correia S, et al. Bariatric postoperative fistula: a life-saving endoscopic procedure. [Internet]. Surg Endosc. 2015;29:1714–20. [cited 2017 Jun 12] Available from: http://link.springer.com/10.1007/s00464-014-3869-z PubMedCrossRef

106.

Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. [Internet]. Surg. Obes. Relat. Dis. 2016;[cited 2017 Apr 4] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1550728916308498

107.

de Jong JR, Besselink MGH, van Ramshorst B, et al. Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review [Internet]. Obes Rev. 2010;11:297–305. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19563457 PubMedCrossRef

108.

Naef M, Mouton WG, Naef U, et al. Esophageal dysmotility disorders after laparoscopic gastric banding--an underestimated complication. [Internet]. Ann Surg. 2011;253:285–90. [cited 2017 Jan 15] Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-201102000-00012 PubMedCrossRef

109.

Dargent J. Esophageal dilatation after laparoscopic adjustable gastric banding: definition and strategy. [Internet]. Obes Surg. 2005;15:843–8. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1381/0960892054222795 PubMedCrossRef

110.

Arias IE, Radulescu M, Stiegeler R, et al. Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity [Internet]. Surg Obes Relat Dis. 2009;5:156–9. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19250879 PubMedCrossRef

111.

Khan A, Ren-Fielding C, Traube M. Potentially reversible pseudoachalasia after laparoscopic adjustable gastric banding. [Internet]. J Clin Gastroenterol. 2011;45:775–9. [cited 2017 Jan 15] Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00004836-201110000-00010 PubMedCrossRef

112.

Fielding GA. Should the lap band be removed to treat pseudoachalasia? [Internet]. Gastroenterol Hepatol (N Y). 2013;9:471–3. [cited 2017 Jan 27] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23935559

113.

Suter M, Giusti V, Héraief E, et al. Band erosion after laparoscopic gastric banding: occurrence and results after conversion to Roux-en-Y gastric bypass [Internet]. Obes Surg. 2004;14:381–6. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15072660 PubMedCrossRef

114.

Abu-Abeid S, Keidar A, Gavert N, et al. The clinical spectrum of band erosion following laparoscopic adjustable silicone gastric banding for morbid obesity. [Internet]. Surg Endosc. 2003;17:861–3. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1007/s00464-002-9195-x PubMedCrossRef

115.

Png KS, Rao J, Lim KH, et al. Lap-band causing left gastric artery erosion presenting with torrential hemorrhage. [Internet]. Obes Surg. 2008;18:1050–2. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1007/s11695-008-9439-5 PubMedCrossRef

116.

Neto MPG, Ramos AC, Campos JM, et al. Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases [Internet]. Surg Obes Relat Dis. 2010;6:423–7. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19926530 PubMedCrossRef

117.

Blero D, Eisendrath P, Vandermeeren A, et al. Endoscopic removal of dysfunctioning bands or rings after restrictive bariatric procedures [Internet]. Gastrointest Endosc. 2010;71:468–74. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19748612 PubMedCrossRef

118.

Abu-Abeid S, Szold A. Results and complications of laparoscopic adjustable gastric banding: an early and intermediate experience [Internet]. Obes Surg. 1999;9:188–90. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10340776 PubMedCrossRef

119.

Keidar A, Carmon E, Szold A, et al. Port complications following laparoscopic adjustable gastric banding for morbid obesity [Internet]. Obes Surg. 2005;15:361–5. [cited 2017 Jan 15] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15826470 PubMedCrossRef

120.

Angrisani L, Furbetta F, Doldi SB, et al. Lap band adjustable gastric banding system: the Italian experience with 1863 patients operated on 6 years. [Internet]. Surg Endosc. 2003;17:409–12. [cited 2017 Jan 15] Available from: http://link.springer.com/10.1007/s00464-002-8836-4 PubMedCrossRef

Title: Endoscopic Evaluation/Management of Bariatric Surgery Complications
Authors: Allison R. Schulman, MD, MPH
Christopher C. Thompson, MD, MSc, FASGE, FACG AGAF
Publication date: 01-12-2017
Publisher: Springer US
Published in: Current Treatment Options in Gastroenterology / Issue 4/2017
Print ISSN: 1092-8472
Electronic ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-017-0164-9

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