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01-05-2015 | Guideline

The role of endoscopy in the bariatric surgery patient

Author: ASGE STANDARDS OF PRACTICE COMMITTEE

Published in: Surgical Endoscopy | Issue 5/2015

Excerpt

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text in conjunction with representatives from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) and the American Society for Metabolic and Bariatric Surgery (ASMBS). In preparing this document, MEDLINE and PubMed databases were used to search for publications between January 1980 and December 2013 pertaining to this topic by using the key words “bariatric surgery” and “endoscopy.” The search was supplemented by accessing the “related articles” feature of PubMed with articles identified on MEDLINE and PubMed as the references. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data were available from well-designed prospective trials, emphasis was given to results from large series and reports from recognized experts. Weaker recommendations are indicated by phrases such as “We suggest…,” whereas stronger recommendations are stated as “We recommend….” The strength of individual recommendations was based on both the aggregate evidence quality (Table 1 ) [1] and an assessment of the anticipated benefits and harms.

Table 1

GRADE system¹ for rating the quality of evidence for guidelines

Quality of evidence	Definition	Symbol
High quality	Further research is very unlikely to change our confidence in the estimate of effect	⊕⊕⊕⊕
Moderate quality	Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate	⊕⊕⊕○
Low quality	Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate	⊕⊕○○
Very low quality	Any estimate of effect is very uncertain	⊕○○○

Adapted from Guyatt et al.¹

…

Guyatt G, Oxman AD, Akl EA et al (2011) GRADE guidelines: introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394PubMed

Anderson MA, Gan SI, Fanelli RD et al (2008) Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 68:1–10PubMed

Kethu SR, Banerjee S, Barth BA et al (2012) Endoluminal bariatric techniques. Gastrointest Endosc 76:1–7PubMed

Flegal KM, Carroll MD, Ogden CL et al (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241PubMed

Finkelstein EA, Khavjou OA, Thompson H et al (2012) Obesity and severe obesity forecasts through 2030. Am J Prev Med 42:563–570PubMed

Adams KF, Schatzkin A, Harris TB et al (2006) Overweight, obesity, and mortality in a large prospective cohort of persons 0 to 71 years old. N Engl J Med 355:763–778PubMed

Zhang C, Rexrode KM, van Dam RM et al (2008) Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation 117:1658–1667PubMed

Reis JP, Araneta MR, Wingard DL et al (2009) Overall obesity and abdominal adiposity as predictors of mortality in U.S. White and black adults. Ann Epidemiol 19:134–142PubMed

McTigue K, Larson JC, Valoski A et al (2006) Mortality and cardiac and vascular outcomes in extremely obese women. JAMA 296:79–86PubMed

10.

Pischon T, Boeing H, Hoffmann K et al (2008) General and abdominal adiposity and risk of death in Europe. N Engl J Med 359:2105–2120PubMed

11.

Whitlock G, Lewington S, Sherliker P et al (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373:1083–1096PubMed

12.

Bray GA (2007) The missing link—lose weight, live longer. N Engl J Med 357:818–820PubMed

13.

Adams TD, Gress RE, Smith SC et al (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761PubMed

14.

Sjostrom L, Narbro K, Sjostrom CD et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752PubMed

15.

NIH conference (1991) Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med 115:956–961

16.

ASMBS Clinical Issues Committee (2013) Bariatric surgery in class I obesity (body mass index 30–35 kg/m²). Surg Obes Relat Dis 9:e1–e10

17.

Feitoza AB, Baron TH (2001) Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part I: reconstruction without alteration of pancreaticobiliary anatomy. Gastrointest Endosc 54:743–749PubMed

18.

Hampel H, Abraham NS, El-Serag HB (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 143:199–211PubMed

19.

Korenkov M, Sauerland S, Shah S et al (2006) Is routine preoperative upper endoscopy in gastric banding patients really necessary? Obes Surg 16:45–47PubMed

20.

Zeni TM, Frantzides CT, Mahr C et al (2006) Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass. Obes Surg 16:142–146PubMed

21.

Loewen M, Giovanni J, Barba C (2008) Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis 4:709–712PubMed

22.

Mong C, Van Dam J, Morton J et al (2008) Preoperative endoscopic screening for laparoscopic Roux-en-Y gastric bypass has a low yield for anatomic findings. Obes Surg 18:1067–1073PubMed

23.

Frigg A, Peterli R, Zynamon A et al (2001) Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up. Obes Surg 11:594–599PubMed

24.

Dolan K, Finch R, Fielding G (2003) Laparoscopic gastric banding and crural repair in the obese patient with a hiatal hernia. Obes Surg 13:772–775PubMed

25.

Erim T, Cruz-Correa MR, Szomstein S et al (2008) Prevalence of Helicobacter pylori seropositivity among patients undergoing bariatric surgery: a preliminary study. World J Surg 32:2021–2025PubMed

26.

Verma S, Sharma D, Kanwar P et al (2013) Prevalence of Helicobacter pylori infection in bariatric patients: a histologic assessment. Surg Obes Relat Dis 9:679–685PubMed

27.

Rasmussen JJ, Fuller W, Ali MR (2007) Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc 21:1090–1094PubMed

28.

Hartin CW Jr, ReMine DS, Lucktong TA (2009) Preoperative bariatric screening and treatment of Helicobacter pylori. Surg Endosc 23:2531–2534PubMed

29.

Papasavas PK, Gagne DJ, Donnelly PE et al (2008) Prevalence of Helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4:383–388PubMed

30.

Almazeedi S, Al-Sabah S, Alshammari D et al (2014) The impact of Helicobacter pylori on the complications of lapaoscopic sleeve gastrectomy. Obes Surg 24:412–415PubMed

31.

Kurian M, Sultan S, Garg K et al (2010) Evaluating gastric erosion in band management: an algorithm for stratification of risk. Surg Obes Relat Dis 6:386–389PubMed

32.

Lee JK, Van Dam J, Morton JM et al (2009) Endoscopy is accurate, safe, and effective in the assessment and management of complications following gastric bypass surgery. Am J Gastroenterol 104:575–582; quiz 83

33.

Wilson JA, Romagnuolo J, Byrne TK et al (2006) Predictors of endoscopic findings after Roux-en-Y gastric bypass. Am J Gastroenterol 101:2194–2199PubMed

34.

Di Francesco V, Baggio E, Mastromauro M et al (2004) Obesity and gastroesophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. Obes Surg 14:1095–1102PubMed

35.

Foster A, Richards WO, McDowell J et al (2003) Gastrointestinal symptoms are more intense in morbidly obese patients. Surg Endosc 17:1766–1768PubMed

36.

Klaus A, Gruber I, Wetscher G et al (2006) Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Arch Surg 141:247–251PubMed

37.

Nelson LG, Gonzalez R, Haines K et al (2005) Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg 71:950–953; discussion 953–954

38.

Cobey F, Oelschlager B (2005) Complete regression of Barrett’s esophagus after Roux-en-Y gastric bypass. Obes Surg 15:710–712PubMed

39.

Suter M, Dorta G, Giusti V et al (2005) Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg 140:639–643PubMed

40.

Westling A, Bjurling K, Ohrvall M et al (1998) Silicone-adjustable gastric banding: disappointing results. Obes Surg 8:467–474PubMed

41.

Howard DD, Caban AM, Cendan JC et al (2011) Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis 7:709–713PubMed

42.

Soricelli E, Iossa A, Casella G et al (2013) Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis 9:356–361PubMed

43.

Monteforte MJ, Turkelson CM (2000) Bariatric surgery for morbid obesity. Obes Surg 10:391–401PubMed

44.

Padoin AV, Galvao Neto M, Moretto M et al (2009) Obese patients with type 2 diabetes submitted to banded gastric bypass: greater incidence of dumping syndrome. Obes Surg 19:1481–1484PubMed

45.

Pories WJ, Caro JF, Flickinger EG et al (1987) The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville gastric bypass. Ann Surg 206:316–323PubMedCentralPubMed

46.

Ahn LB, Huang CS, Forse RA et al (2005) Crohn’s disease after gastric bypass surgery for morbid obesity: is there an association? Inflamm Bowel Dis 11:622–624PubMed

47.

Shen B, Khan K, Ikenberry SO et al (2010) The role of endoscopy in the management of patients with diarrhea. Gastrointest Endosc 71:887–892PubMed

48.

Cherian PT, Goussous G, Ashori F et al (2010) Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years. Surg Endosc 24:2031–2038PubMed

49.

Weiner R, Blanco-Engert R, Weiner S et al (2003) Outcome after laparoscopic adjustable gastric banding—8 years experience. Obes Surg 13:427–434PubMed

50.

Keidar A, Szold A, Carmon E et al (2005) Band slippage after laparoscopic adjustable gastric banding: etiology and treatment. Surg Endosc 19:262–267PubMed

51.

Singhal R, Bryant C, Kitchen M et al (2010) Band slippage and erosion after laparoscopic gastric banding: a meta-analysis. Surg Endosc 24:2980–2986PubMed

52.

Foletto M, De Marchi F, Bernante P et al (2005) Late gastric pouch necrosis after Lap-Band, treated by an individualized conservative approach. Obes Surg 15:1487–1490PubMed

53.

Iannelli A, Facchiano E, Sejor E et al (2005) Gastric necrosis: a rare complication of gastric banding. Obes Surg 15:1211–1214PubMed

54.

Adam LA, Silva RG Jr, Rizk M et al (2007) Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty. Gastrointest Endosc 65:337–340PubMed

55.

Evans JA, Williams NN, Chan EP et al (2006) Endoscopic removal of eroded bands in vertical banded gastroplasty: a novel use of endoscopic scissors (with video). Gastrointest Endosc 64:801–804PubMed

56.

El-Hayak K, Timratana P, Brethauer SA et al (2013) Complete endoscopic/transgastric retrieval of eroded gastric band: description of a novel technique and review of the literature. Surg Endosc 27:2974–2979

57.

Azagury DE, Abu Dayyeh BK, Greenwalt IT et al (2011) Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy 43:950–954PubMed

58.

El-Hayek K, Timratana P, Shimizu H et al (2012) Marginal ulcer after Roux-en-Y gastric bypass: what have we really learned? Surg Endosc 26:2789–2796PubMed

59.

MacLean LD, Rhode BM, Nohr C et al (1997) Stomal ulcer after gastric bypass. J Am Coll Surg 185:1–7PubMed

60.

Carrodeguas L, Szomstein S, Soto F et al (2005) Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis 1:467–474PubMed

61.

Filho AJ, Kondo W, Nassif LS et al (2006) Gastrogastric fistula: a possible complication of Roux-en-Y gastric bypass. JSLS 10:326–331PubMedCentralPubMed

62.

Gould JC, Garren MJ, Starling JR (2004) Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program. Obes Surg 14:618–625PubMed

63.

Gumbs AA, Duffy AJ, Bell RL (2006) Management of gastrogastric fistula after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2:117–121PubMed

64.

Carucci LR, Turner MA, Conklin RC et al (2006) Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology 238:119–127PubMed

65.

Gonzalez R, Sarr MG, Smith CD et al (2007) Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 204:47–55PubMed

66.

Eisendrath P, Cremer M, Himpens J et al (2007) Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy 39:625–630PubMed

67.

Merrifield BF, Lautz D, Thompson CC (2006) Endoscopic repair of gastric leaks after Roux-en-Y gastric bypass: a less invasive approach. Gastrointest Endosc 63:710–714PubMed

68.

Brolin RE, Lin JM (2013) Treatment of gastric leaks after Roux-en-Y gastric bypass: a paradigm shift. Surg Obes Relat Dis 9:229–233PubMed

69.

Spyropoulos C, Argentou MI, Petsas T et al (2012) Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis 8:609–615PubMed

70.

Evans JA, Branch MS, Pryor AD et al (2007) Endoscopic closure of a gastrojejunal anastomotic leak (with video). Gastrointest Endosc 66:1225–1226PubMed

71.

Papavramidis ST, Eleftheriadis EE, Papavramidis TS et al (2004) Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc 59:296–300PubMed

72.

Fukumoto R, Orlina J, McGinty J et al (2007) Use of Polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis 3:68–71; discussion 72

73.

Kriwanek S, Ott N, Ali-Abdullah S et al (2006) Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated selfexpanding stents. Obes Surg 16:1669–1674PubMed

74.

Salinas A, Baptista A, Santiago E et al (2006) Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2:570–572PubMed

75.

Roberts KE, Duffy AJ, Bell RL (2007) Laparoscopic transgastric repair of a gastrogastric fistula after gastric bypass: a novel technique. Surg Innov 14:18–23PubMed

76.

Torres-Villalobos G, Leslie D, Kellogg T et al (2007) A new approach for treatment of gastro-gastric fistula after gastric bypass. Obes Surg 17:242–246PubMed

77.

Carrodeguas L, Szomstein S, Zundel N et al (2006) Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis 2:92–97PubMed

78.

Messmer JM, Wolper JC, Sugerman HJ (1984) Stomal disruption in gastric partition in morbid obesity (comparison of radiographic and endoscopic diagnosis). Am J Gastroenterol 79:603–605PubMed

79.

Podnos YD, Jimenez JC, Wilson SE et al (2003) Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 138:957–961PubMed

80.

Sanyal AJ, Sugerman HJ, Kellum JM et al (1992) Stomal complications of gastric bypass: incidence and outcome of therapy. Am J Gastroenterol 87:1165–1169PubMed

81.

Escalona A, Devaud N, Boza C et al (2007) Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator. Surg Endosc 21:765–768PubMed

82.

Peifer KJ, Shiels AJ, Azar R et al (2007) Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. Gastrointest Endosc 66:248–252PubMed

83.

Go MR, Muscarella P 2nd, Needleman BJ et al (2004) Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc 18:56–59PubMed

84.

Hwang RF, Swartz DE, Felix EL (2004) Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc 18:1631–1635PubMed

85.

Wetter A (2007) Role of endoscopy after Roux-en-Y gastric bypass surgery. Gastrointest Endosc 66:253–255PubMed

86.

Parikh A, Alley JB, Peterson RM et al (2012) Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc 26:738–746PubMed

87.

Ryou M, Mogabgab O, Lautz DB et al (2010) Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass. Surg Obes Relat Dis 6:526–531PubMed

88.

Yu S, Jastrow K, Clapp B et al (2007) Foreign material erosion after laparoscopic Roux-en-Y gastric bypass: findings and treatment. Surg Endosc 21:1216–1220PubMed

89.

Parameswaran R, Ferrando J, Sigurdsson A (2006) Gastric bezoar complicating laparoscopic adjustable gastric banding with band slippage. Obes Surg 16:1683–1684PubMed

90.

Veronelli A, Ranieri R, Laneri M et al (2004) Gastric bezoars after adjustable gastric banding. Obes Surg 14:796–797PubMed

91.

Powers WF, Miles DR (2011) Phytobezoar causing small bowel obstruction seven years after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 7:e3–e5PubMed

92.

Roy M, Fendrich I, Li J et al (2012) Treatment option in patient presenting with small bowel obstruction from phytobezoar at the jejunojejunal anastomosis after Roux-en-Y gastric bypass. Surg Laparosc Endosc Percutan Tech 22:e243–e245PubMed

93.

Sarhan M, Shyamali B, Fakulujo A et al (2010) Jejunal Bezoar causing obstruction after laparoscopic Roux-en-Y gastric bypass. JSLS 14:592–595PubMedCentralPubMed

94.

Pinto D, Carrodeguas L, Soto F et al (2006) Gastric bezoar after laparoscopic Roux-en-Y gastric bypass. Obes Surg 16:365–368PubMed

95.

Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737PubMed

96.

Nguyen NT, Longoria M, Chalifoux S et al (2004) Gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg 14:1308–1312PubMed

97.

Biertho L, Steffen R, Ricklin T et al (2003) Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg 197:536–544PubMed

98.

Rao AD, Ramalingam G (2006) Exsanguinating hemorrhage following gastric erosion after laparoscopic adjustable gastric banding. Obes Surg 16:1675–1678PubMed

99.

Sakai P, Kuga R, Safatle-Ribeiro AV et al (2005) Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope. Endoscopy 37:566–569PubMed

100.

Sundbom M, Nyman R, Hedenstrom H et al (2001) Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obes Surg 11:25–27PubMed

101.

Amaral JF, Thompson WR, Caldwell MD et al (1985) Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg 201:186–193PubMedCentralPubMed

102.

Halverson JD (1986) Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg 52:594–598PubMed

103.

Villegas L, Schneider B, Provost D et al (2004) Is routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg 14:206–211PubMed

104.

Puzziferri N, Austrheim-Smith IT, Wolfe BM et al (2006) Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg 243:181–188PubMedCentralPubMed

105.

Wudel LJ Jr, Wright JK, Debelak JP et al (2002) Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res 102:50–56PubMed

106.

Wright BE, Cass OW, Freeman ML (2002) ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 56:225–232PubMed

107.

Lennon AM, Kapoor S, Khashab M et al (2012) Spiral assisted ERCP is equivalent to single balloon assisted ERCP in patients with Roux-en-Y anatomy. Dig Dis Sci 57:1391–1398PubMed

108.

Shah RJ, Smolkin M, Yen R et al (2013) A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc 77:593–600PubMed

109.

Ceppa FA, Gagne DJ, Papasavas PK et al (2007) Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass. Surg Obes Relat Dis 3:21–24PubMed

110.

Martinez J, Guerrero L, Byers P et al (2006) Endoscopic retrograde cholan- giopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass. Surg Endosc 20:1548–1550PubMed

111.

Schreiner MA, Chang L, Gluck M et al (2012) Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 75:748–756PubMed

112.

Tekola B, Wang AY, Ramanath M et al (2011) Percutaneous gastrostomy tube placement to perform transgastrostomy endoscopic retrograde cholangiopancreaticography in patients with Roux-en-Y anatomy. Dig Dis Sci 56:3364–3369PubMed

113.

Law R, Wong Kee Song LM, Petersen BT et al (2013) Single-session ERCP in patients with previous Roux-en-Y gastric bypass using transprosthetic endoscopic therapy: a case series. Endoscopy 45:671–675PubMed

114.

Catalano MF, Rudic G, Anderson AJ et al (2007) Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc 66:240–245PubMed

Title: The role of endoscopy in the bariatric surgery patient
Author: ASGE STANDARDS OF PRACTICE COMMITTEE
Publication date: 01-05-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4111-3

At a glance: The STEP trials

Springer Medicine

The role of endoscopy in the bariatric surgery patient

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At a glance: The STEP trials

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Excerpt

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