Editorial
Role of endoscopy after Roux-en-Y gastric bypass surgery

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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

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    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.

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See CME section; p. 335.

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