7. The Role of Endoscopy in Bariatric Surgery

Abstract

Bariatric surgery has evolved to occupy a prominent place in the practice of surgery. There are over 200,000 and probably closer to 220,000 bariatric operations performed every year in the USA, making it one of the leading individual areas of surgery in many hospitals in terms of case volume. The rise in popularity of bariatric surgery began just over a decade ago, when volumes escalated from about 20,000 cases per year in the 1998 era to about 140,000 cases per year by the year 2003. During that 5-year period, the performance of bariatric surgery evolved from using an open approach to a laparoscopic approach. This was the likely major source of the rise in popularity. Since then, there has been a steady but less dramatic annual increase in case volume. As more procedures are done, the prevalence of bariatric patients with perioperative and postoperative symptoms and problems, many of which can and should be addressed endoscopically, is also rising. The need for the bariatric surgeon to also be a flexible endoscopist is now greater than ever. Fortunately, many are doing so. Patients also seek health care in emergency rooms, clinics, and hospitals, where their bariatric surgeon is not located. Thus, there is a need for those surgeons and nonsurgeons performing flexible endoscopy to be appropriately familiar with the anatomy of various bariatric operations, as well as to the prevalent pathologic conditions which accompany these different bariatric procedures and their treatment. It is to that end that this chapter is written.

The text is divided into sections as other chapters in this text. However, the addition of a description of the various bariatric operations that are likely to be encountered by the endoscopist must by necessity be added to this chapter for orientation as to the alimentary tract anatomy for each operation. Some special aspects of the performance of flexible endoscopy in the bariatric surgery patient population are addressed as well.