Abstract
The increasing number of bariatric surgical procedures performed results from its efficacy in the management of morbid obesity. This increase leads to the increased incidence of postoperative bariatric complications. Fortunately, the modern bariatric endoscopist has an array of endoscopic tools available to manage postoperative complications including endoscopic stenting, clipping, and suctioning techniques. Appropriately deploying one or more of these options effectively manages many of the dreaded postoperative complications including anastomotic leaks, strictures, and bleeding. These lower morbidity endoscopic alternatives can provide durable primary definitive outcomes or valuable opportunities for patient optimization, safely bridging the patient to later definitive operative management.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52. https://doi.org/10.1056/NEJMoa066254.
Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32. https://doi.org/10.1016/j.surg.2007.07.018; discussion 632–635.
Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: development of standards for patient safety and efficacy. Metabolism. 2018;79:97–107. https://doi.org/10.1016/j.metabol.2017.12.010.
Fernandez AZ, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–7. https://doi.org/10.1007/s00464-003-8926-y.
Souto-Rodríguez R, Alvarez-Sánchez M-V. Endoluminal solutions to bariatric surgery complications: a review with a focus on technical aspects and results. World J Gastrointest Endosc. 2017;9(3):105–26. https://doi.org/10.4253/wjge.v9.i3.105.
Jiang H-P, Lin L-L, Jiang X, Qiao H-Q. Meta-analysis of hand-sewn versus mechanical gastrojejunal anastomosis during laparoscopic Roux-en-Y gastric bypass for morbid obesity. Int J Surg Lond Engl. 2016;32:150–7. https://doi.org/10.1016/j.ijsu.2016.04.024.
Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133–41. https://doi.org/10.1007/s11695-015-1703-x.
Varban OA, Cassidy RB, Sheetz KH, et al. Technique or technology? Evaluating leaks after gastric bypass. Surg Obes Relat Dis. 2016;12(2):264–72. https://doi.org/10.1016/j.soard.2015.07.013.
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(2):287–93. https://doi.org/10.1016/j.gie.2011.09.010.
Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55. https://doi.org/10.1016/j.jamcollsurg.2006.09.023.
Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–23. https://doi.org/10.1002/bjs.9388.
Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19. https://doi.org/10.1016/j.soard.2011.10.019.
Biancari F, D’Andrea V, Paone R, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg. 2013;37(5):1051–9. https://doi.org/10.1007/s00268-013-1951-7.
Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5. https://doi.org/10.1007/s00464-012-2426-x.
Sharma G, Ardila-Gatas J, Boules M, et al. Upper gastrointestinal endoscopy is safe and feasible in the early postoperative period after Roux-en-Y gastric bypass. Surgery. 2016;160(4):885–91. https://doi.org/10.1016/j.surg.2016.07.001.
El Hajj II, Imperiale TF, Rex DK, et al. Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes. Gastrointest Endosc. 2014;79(4):589–98. https://doi.org/10.1016/j.gie.2013.08.039.
Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis. 2018;14(3):393–403. https://doi.org/10.1016/j.soard.2017.12.014.
Murino A, Arvanitakis M, Le Moine O, Blero D, Devière J, Eisendrath P. Effectiveness of endoscopic management using self-expandable metal stents in a large cohort of patients with post-bariatric leaks. Obes Surg. 2015;25(9):1569–76. https://doi.org/10.1007/s11695-015-1596-8.
Aryaie AH, Singer JL, Fayezizadeh M, Lash J, Marks JM. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc. 2017;31(2):612–7. https://doi.org/10.1007/s00464-016-5005-8.
Singer JL, Aryaie AH, Fayezizadeh M, Lash J, Marks JM. Predictive factors for the migration of endoscopic self-expanding metal stents placed in the foregut. Surg Innov. 2017;24(4):353–7. https://doi.org/10.1177/1553350617702026.
Romagnuolo J. Endoscopic clips: past, present and future. Can J Gastroenterol. 2009;23(3):158–60.
Keren D, Eyal O, Sroka G, et al. Over-the-scope clip (OTSC) system for sleeve gastrectomy leaks. Obes Surg. 2015;25(8):1358–63. https://doi.org/10.1007/s11695-014-1540-3.
Mercky P, Gonzalez J-M, Aimore Bonin E, et al. Usefulness of over-the-scope clipping system for closing digestive fistulas. Dig Endosc. 2015;27(1):18–24. https://doi.org/10.1111/den.12295.
Shehab H, Abdallah E, Gawdat K, Elattar I. Large bariatric-specific stents and over-the-scope clips in the management of post-bariatric surgery leaks. Obes Surg. 2018;28(1):15–24. https://doi.org/10.1007/s11695-017-2808-1.
Schmidt F, Mennigen R, Vowinkel T, et al. Endoscopic vacuum therapy (EVT)-a new concept for complication management in bariatric surgery. Obes Surg. 2017;27(9):2499–505. https://doi.org/10.1007/s11695-017-2783-6.
Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch K-W. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 2008;22(8):1818–25. https://doi.org/10.1007/s00464-007-9706-x.
Bludau M, Fuchs HF, Herbold T, et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc. 2018;32(4):1906–14. https://doi.org/10.1007/s00464-017-5883-4.
Ooi G, Burton P, Packiyanathan A, et al. Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations. ANZ J Surg. 2018;88(4):E257–63. https://doi.org/10.1111/ans.13837.
Bouchard S, Eisendrath P, Toussaint E, et al. Trans-fistulary endoscopic drainage for post-bariatric abdominal collections communicating with the upper gastrointestinal tract. Endoscopy. 2016;48(9):809–16. https://doi.org/10.1055/s-0042-108726.
Donatelli G, Dumont J-L, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 2015;25(7):1293–301. https://doi.org/10.1007/s11695-015-1675-x.
Khoursheed M, Al-Bader I, Mouzannar A, et al. Postoperative bleeding and leakage after sleeve gastrectomy: a single-center experience. Obes Surg. 2016;26(12):2944–51. https://doi.org/10.1007/s11695-016-2215-z.
Jamil LH, Krause KR, Chengelis DL, et al. Endoscopic management of early upper gastrointestinal hemorrhage following laparoscopic Roux-en-Y gastric bypass. Am J Gastroenterol. 2008;103(1):86–91. https://doi.org/10.1111/j.1572-0241.2007.01588.x.
Tang S-J, Rivas H, Tang L, Lara LF, Sreenarasimhaiah J, Rockey DC. Endoscopic hemostasis using endoclip in early gastrointestinal hemorrhage after gastric bypass surgery. Obes Surg. 2007;17(9):1261–7.
Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21(7):1090–4. https://doi.org/10.1007/s00464-007-9285-x.
Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(5):760–4. https://doi.org/10.1016/j.soard.2012.06.012.
Ryou M, Mogabgab O, Lautz DB, Thompson CC. Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(5):526–31. https://doi.org/10.1016/j.soard.2010.02.035.
Deslauriers V, Beauchamp A, Garofalo F, et al. Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis. Surg Endosc. 2018;32(2):601–9. https://doi.org/10.1007/s00464-017-5709-4.
Go MR, Muscarella P, Needleman BJ, Cook CH, Melvin WS. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc. 2004;18(1):56–9. https://doi.org/10.1007/s00464-003-8919-x.
Ukleja A, Afonso BB, Pimentel R, Szomstein S, Rosenthal R. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc. 2008;22(8):1746–50. https://doi.org/10.1007/s00464-008-9788-0.
Escalona A, Devaud N, Boza C, et al. Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator. Surg Endosc. 2007;21(5):765–8. https://doi.org/10.1007/s00464-006-9134-3.
Quadri P, Gonzalez-Heredia R, Masrur M, Sanchez-Johnsen L, Elli EF. Management of laparoscopic adjustable gastric band erosion. Surg Endosc. 2017;31(4):1505–12. https://doi.org/10.1007/s00464-016-5183-4.
Neto MPG, Ramos AC, Campos JM, et al. Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases. Surg Obes Relat Dis. 2010;6(4):423–7. https://doi.org/10.1016/j.soard.2009.09.016.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hodgens, B., Bueno, R.S. (2019). Interventional Endoscopy: Endoluminal Therapy – Stenting, Clipping, and Suctioning. In: Lim, R. (eds) Multidisciplinary Approaches to Common Surgical Problems. Springer, Cham. https://doi.org/10.1007/978-3-030-12823-4_3
Download citation
DOI: https://doi.org/10.1007/978-3-030-12823-4_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-12822-7
Online ISBN: 978-3-030-12823-4
eBook Packages: MedicineMedicine (R0)