EditorialRole of endoscopy after Roux-en-Y gastric bypass surgery
Section snippets
Early need for endoscopy (less than 6 weeks after surgery)
In this immediate postoperative period, it is unusual for patients to require endoscopy. Yet, bleeding at the anastomotic site may require endoscopic electrocautery ablation of the suture or the staple line, or even clipping of a bleeding vessel. Dysphagia to liquids usually resolves after a couple of days, but if it persists, it may be because of anastomotic edema or a retained clot. Conservative management is recommended for a few days. If this fails, early balloon dilation to a maximum of
Six to 8 weeks after surgery
Most anastomotic strictures of the gastrojejunostomy occur during this period. Whether tension at the anastomosis or scar-tissue formation is the cause remains unknown. In such cases, the clinical presentation is insidious, with patients experiencing a gradual progression of dysphagia to soft foods and later to liquids or, eventually, an inability to advance the diet to solids at the expected rate. This is accompanied by a faster pace of weight reduction, more than the expected. Although an
Late needs (2 months after surgery and beyond)
Endoscopy is, again, rarely needed during this period. Anastomotic ulceration and strictures may develop in patients who abuse nonsteroidal anti-inflammatory drugs, tobacco, or alcohol, and may require endoscopy for diagnosis or treatment. Retrosternal pain or discomfort upon eating, as well as intermittent dysphagia may be common presenting symptoms. Management of these late strictures usually involves withdrawing the causative agent, a course of sucralfate or acid suppressants(proton pump
References (3)
- et al.
Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients
Surg Obes Relat Dis
(2006)
Cited by (17)
Endoluminal Procedures for the Treatment and Management of Bariatric Patients
2017, Metabolism and Pathophysiology of Bariatric Surgery: Nutrition, Procedures, Outcomes and Adverse EffectsEndoscopic management of bariatric surgery complications: What the gastroenterologist should know
2016, Revista de Gastroenterologia de MexicoThe role of endoscopy in the bariatric surgery patient
2015, Surgery for Obesity and Related DiseasesThe role of endoscopy in the bariatric surgery patient
2015, Gastrointestinal EndoscopyThe cooperation between endoscopists and surgeons in treating complications of bariatric surgery
2014, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Being an end-to-side anastomosis, it gives the endoscopist a double-barrel view. There is typically a short (1–2 cm) blind limb of jejunum just distal to the gastrojejunostomy, which may be perforated easily by too much pressure by the endoscope or by wires and balloons [11,19]. For the construction of the gastrojejunostomy, a circular or linear stapler is used and staples can be recognised.
Endoscopic management of complications after gastrointestinal weight loss surgery
2013, Clinical Gastroenterology and HepatologyCitation Excerpt :In cases of stricture formation incited by ulcer or foreign material, presentation may be delayed for months or years. Medical factors predisposing patients to stricture formation include use of NSAIDs, smoking, and alcohol.50 Surgical factors include method for anastomosis construction and mechanical tension or ischemia at the anastomosis.
See CME section; p. 335.