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Endoscopic Management of Stomal Stenosis

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The ASMBS Textbook of Bariatric Surgery

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Abstract

The number of bariatric procedures being performed in the United States continues to increase. The obesity rates in the United States continue to rise as well, despite millions of dollars being spent in healthcare and education to help treat obesity. Currently, the two most common bariatric surgeries performed are the vertical sleeve gastrectomy (VSG) and Roux-en-y gastric bypass (RYGB). With the continued evolution of bariatric procedures, the bariatric surgeon should be comfortable with diagnostic and therapeutic endoscopy to evaluate and treat patient complaints and symptoms in the pre- and postoperative period. Complications of the VSG can include postoperative leak, bleeding, and stenosis. Complications associated with RYGB can vary based on timing. During the perioperative period (0–72 h), patients may experience bleeding, venous thromboembolism, myocardial infarction, or leak. Acute complications include bowel obstruction, surgical site infection, venous thromboembolism, pneumonia, and stricture. Anastomotic stricture, marginal ulceration, gastro-gastric or gastrocutaneous fistula, bowel obstruction, hernia, and others can all be seen after 8 weeks postoperatively. This chapter will focus on the utilization of endoscopy to treat stenosis in sleeve and gastric bypass patients. Currently the most common procedure to treat stoma stenosis is endoscopic balloon dilation. Other endoscopic treatment options include self-expandable metal stents, bougie dilation, and needle-knife papillotome. For those patients that fail endoscopic treatment of stoma stenosis, revision surgery may be necessary.

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Author information

Authors and Affiliations

  1. Minimally Invasive Surgery, Bariatric Surgery, Department of General Surgery, Loma Linda University Health, Loma Linda, CA, USA

    Crystal E. Alvarez

  2. Bariatric Surgery, Department of General Surgery, Loma Linda University Health, Loma Linda, CA, USA

    Keith Scharf

Authors
  1. Crystal E. Alvarez
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  2. Keith Scharf
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Corresponding author

Correspondence to Keith Scharf .

Editor information

Editors and Affiliations

  1. Department of Surgery, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center, Orange, CA, USA

    Ninh T. Nguyen

  2. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Stacy A. Brethauer

  3. Bariatric and Minimally Invasive Surgery Division, Yale School of Medicine, New Haven, CT, USA

    John M. Morton

  4. Bariatric Surgery, Metabolic and Bariatric Care, CHI Memorial Hospital, Chattanooga, TN, USA

    Jaime Ponce

  5. Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA

    Raul J. Rosenthal

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Alvarez, C.E., Scharf, K. (2020). Endoscopic Management of Stomal Stenosis. In: Nguyen, N., Brethauer, S., Morton, J., Ponce, J., Rosenthal, R. (eds) The ASMBS Textbook of Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-27021-6_37

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  • DOI: https://doi.org/10.1007/978-3-030-27021-6_37

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  • Online ISBN: 978-3-030-27021-6

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