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Endoscopic treatment of complications after bariatric surgery – overview of issues and retrospective analysis of our own results


Authors: V. Nosek 1;  M. Řehoř 1;  J. Pintová 1;  M. Man 2;  M. Vraný 2;  R. Procházka 1
Authors‘ workplace: Oddělení gastroenterologie, Nemocnice Jablonec, nad Nisou p. o. 1;  Chirurgické oddělení, Nemocnice Jablonec, nad Nisou p. o. 2
Published in: Rozhl. Chir., 2024, roč. 103, č. 9, s. 336-345.
Category: Review
doi: https://doi.org/10.48095/ccrvch2024336

Overview

Bariatric and metabolic surgery is the most invasive but also the most effective treat­ment for severe obesity and associated comorbidities. The most common procedures performed are laparoscopic sleeve gastrectomy and Roux-Y gastric bypass. Postoperative complications occur in 4–10% cases. The majority of them are mild and are treated conservatively. Complex management of severe complications often involves surgical re-intervention, which is associated with high morbidity. Technological advancements in therapeutic endoscopy expand the options for minimally invasive treatment of these complications and, in selected cases, may even be the method of choice in their management. The authors present a summary of current endoscopic procedures for managing ulcerations, leaks, fistulas, strictures, and other complications. Based on a cohort of 45 patients treated over a period of 10 years (11/2013–11/2023) at the district hospital in Jablonec nad Nisou, an overview of the endoscopic methods used, procedure numbers, duration, and outcomes of endoscopic treatment is provided. The author’s commentary describes trends leading to further improvement in the outcomes of endoscopic treatment.

Keywords:

endoscopy – bariatric surgery – bariatric complications – minimally invasive


Sources

1.           Ardila-Gatas J, Pryor A. Endoscopic approach for the treatment of bariatric surgery complications. Mini-invasive Surg 2020; 4(1): 16. doi: 10.20517/2574-1225.2019.69.

2.           de Moura DTH, Dantas ACB, Ribeiro IB et al. Status of bariatric endoscopy-what does the surgeon need to know? World J Gastrointest Surg 2022; 14(2): 185–199. doi: 10.4240/wjgs.v14.i2.185.

3.           de Oliveira VL, Bestetti AM, Trasolini RP et al. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: basic principles and recommendations. World J Gastroenterol 2023; 29(7): 1173–1193. doi: 10.3748/wjg.v29.i7.1173.

4.           Boškoski I, Pontecorvi V, Ibrahim M et al. Curriculum for bariatric endoscopy and endoscopic treatment of the complications of bariatric surgery: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 2023; 55(3): ­276–­293. doi: 10.1055/a-2003-5818.

5.           Rodrigo DC, Jill S, Daniel M et al. Which factors correlate with marginal ulcer after surgery for obesity? Obes Surg 2020; 30(12): 4821–4827. doi: 10.1007/s11695-020-04960-z.

6.           Storm AC, Thompson CC. Endoscopic treatments following bariatric surgery. Gastrointest Endosc Clin N Am 2017; 27(2): 233–244. doi: 10.1016/j.giec.2016.12.007.

7.           Frezza EE, Herbert H, Ford R et al. Endoscopic suture removal at gastrojejunal anastomosis after Roux-en-Y gastric bypass to prevent marginal ulceration. Surg Obes Relat Dis 2007; 3(6): 619–622. doi: 10.1016/j.soard.2007.08.019.

8.           Liu S, Kim R. Successful closure with endoscopic suturing of a recalcitrant mar ginal ulcer despite Roux-en-Y gastric bypass reversion. VideoGIE 2019; 4(12): 554–555. doi: 10.1016/j.vgie.2019.09.001.

9.           Griffith PS, Birch DW, Sharma AM et al. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity. Can J Surg 2012; 55(5): 329–336. doi: 10.1503/cjs.002011.

10.         Vargas EJ, Abu Dayyeh BK. Keep calm under pressure: a paradigm shift in man aging postsurgical leaks. Gastrointest Endosc 2018; 87(2): 438–441. doi: 10.1016/j.gie.2017.09.016.

11.         Shoar S, Poliakin L, Khorgami Z et al. Efficacy and safety of the Over-the-Scope Clip (OTSC) system in the management of leak and fistula after laparoscopic sleeve gastrectomy: a systematic review. Obes Surg 2017; 27(9): 2410–2418. doi: 10.1007/s11695-017-2651-4.

12.         de Moura DTH, Sachdev AH, Thompson CC. Endoscopic full-thickness defects and closure techniques. Curr Treat Options Gastroenterol 2018; 16(4): 386–405. doi: 10.1007/s11938-018-0199-6.

13.         Kim J, Azagury D, Eisenberg D et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015; 11(4): 739–748. doi: 10.1016/j.soard.2015.05.001.

14.         Okazaki O, Bernardo WM, Brunaldi VO et al. Efficacy and safety of stents in the treatment of fistula after bariatric surgery: a systematic review and meta-analysis. Obes Surg 2018; 28(6): 1788–1796. doi: 10.1007/s11695-018-3236-6.

15.         Law R, Prabhu A, Fujii-Lau L et al. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc 2018; 32(2): 675–681. doi: 10.1007/s00464-017-5720-9.

16.         Lorenzo D, Guilbaud T, Gonzalez JM et al. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc 2018; 87(2): 429–437. doi: 10.1016/j.gie.2017.07.032.

17.         Donatelli G, Spota A, Cereatti F et al. Endoscopic internal drainage for the man agement of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis 2021; 17(8): 1432–1439. doi: 10.1016/j.soard.2021.03.013.

18.         do Monte Junior ES, de Moura DTH, Ribeiro IB et al. Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: systematic review and meta-analysis. Dig Endosc 2021; 33(6): 892–902. doi: 10.1111/den.13813.

19.         Ardila-Gatas J, English W. Endoscopic management of early complications following bariatric surgery. Mini-invasive Surg 2022; 6(1): 21. doi: 10.20517/2574-1225.2021.133.

20.         Intriago JMV, de Moura DTH, do Monte Junior ES et al. Endoscopic Vacuum Therapy (EVT) for the treatment of post-bariatric surgery leaks and fistulas: a systematic review and meta-analysis. Obes Surg 2022; 32(10): 3435–3451. doi: 10.1007/s11695-022-06228-0.

21.         Baretta G, Campos J, Correia S et al. Bariatric postoperative fistula: a life-saving endoscopic procedure. Surg Endosc 2015; 29(7): 1714–1720. doi: 10.1007/s00464-014-3869-z.

22.         Gala K, Brunaldi V, Abu Dayyeh BK. Endoscopic management of surgical complications of bariatric surgery. Gastroenterol Clin North Am 2023; 52(4): 719–731. doi: 10.1016/j.gtc.2023.08.004.

23.         Rebibo L, Hakim S, Dhahri A et al. Gastric stenosis after laparoscopic sleeve gastrectomy: diagnosis and management. Obes Surg 2016; 26(5): 995–1001. doi: 10.1007/s11695-015-1883-4.

24.         Donatelli G, Dumont JL, Pourcher G et al. Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up (with videos). Surg Obes Relat Dis 2017; 13(6): 943–950. doi: 10.1016/j.soard.2016.09.023.

25.         Brunaldi VO, Galvao Neto M, Zundel N et al. Isolated sleeve gastrectomy stricture: a systematic review on reporting, workup, and treatment. Surg Obes Relat Dis 2020; 16(7): 955–966. doi: 10.1016/j.soard.2020.03.006.

26.         Almby K, Edholm D. Anastomotic strictures after Roux-en-Y gastric bypass: a cohort study from the scandinavian obesity surgery registry. Obes Surg 2019; 29(1): 172–177. doi: 10.1007/s11695-018-3500-9.

27.         Ukleja A, Afonso BB, Pimentel R et al. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc 2008; 22(8): ­1746–­1750. doi: 10.1007/s00464-008-9788-0.

28.         de Moura EGH, Orso IRB, Aurelio EF et al. Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2016; 12(3): 582–586. doi: 10.1016/j.soard.2015.11.006.

29.         Carrodeguas L, Szomstein S, Zundel N et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis 2006; 2(2): 92–97. doi: 10.1016/j.soard.2005.10.014.

30.         Larsen M, Kozarek R. Therapeutic endoscopy for the treatment of post-bariatric surgery complications. World J Gastroenterol 2022; 28(2): 199–215. doi: 10.3748/wjg.v28.i2.199.

31.         Skidmore AP. Use of lumen-apposing metal stents (LAMS) in the management of gastro jejunostomy stricture following Roux-en-Y gastric bypass for obesity: a prospective series. BMC Surg 2021; 21(1): 314. doi: 10.1186/s12893-021-01310-3.

32.         Jin D, Xu M, Huang K et al. The efficacy and long-term outcomes of endoscopic full-thickness suturing for chronic gastrointestinal fistulas with an Overstitch de vice: is it a durable closure? Surg Endosc 2022; 36(2): 1347–1354. doi: 10.1007/s00464-021-08412-2.

33.         Vargas EJ, Abu Dayyeh BK, Storm AC et al. Endoscopic management of dumping syndrome after Roux-en-Y gastric bypass: a large international series and proposed management strategy. Gastrointest Endosc 2020; 92(1): 91–96. doi: 10.1016/j.gie.2020.02.029.

34.         Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 2011; 9(3): 228–233. doi: 10.1016/j.cgh.2010.11.004.

35.         Shiffman ML, Sugerman HJ, Kellum JM et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol 1991; 86(8): ­1000–­1005.

36.         Ayoub F, Brar TS, Banerjee D et al. Laparoscopy-assisted versus enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass: a meta-analysis. Endosc Int Open 2020; 8(3): E423–E436. doi: 10.1055/a-1070-9132.

37.         Skinner M, Popa D, Neumann H et al. ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy 2014; 46(7): 560–572. doi: 10.1055/s-0034-1365698.

38.         Runge TM, Chiang AL, Kowalski TE et al. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study. Endoscopy 2021; 53(6): 611–618. doi: 10.1055/a-1254-3942.

39.         Wilson TD, Miller N, Brown N et al. Stent induced gastric wall erosion and endoscopic retrieval of nonadjustable gastric band: a new technique. Surg Endosc 2013; 27(5): 1617–1621. doi: 10.1007/s00464-012-2638-0.

40.         Robinson TJ, Soriano C, Larsen M et al. Endoscopic removal of eroded laparoscopic adjustable gastric bands: a preferred approach. Surg Obes Relat Dis 2020; 16(8): 1030–1034. doi: 10.1016/j.soard.2020.04.034.

MUDr. Vladimír Nosek

Oddělení gastroenterologie

Nemocnice Jablonec nad Nisou p.o.

Nemocniční 4446/15

466 01 Jablonec nad Nisou

nosek@nemjbc.cz

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