Файловый архив студентов. Файловый архив студентов.
1327 вузов, 5482 предметов.
/ Регистрация
FAQ Обратная связь Вопросы и предложения
Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Ростовский Государственный Медицинский Университет
Предмет:
Медицина общая
Файл:

Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 566 - файл

.pdf
Скачиваний:
0
Добавлен:
29.08.2026
Размер:
24 Мб
Скачать
☆
16 Endoscopic Evaluation oftheBariatric Surgery Patient
https://t.me/medicina_free
223
Anemia andGI Bleed
Anemia in the postbariatric patient can be from iron or vitamin B12 deciency. GI bleeding can also contribute to anemia and should be evaluated with endoscopy. Bleeding from the staple tines occurs in 1–4% of patients undergoing any stapled bariatric surgery [71]. The excluded stomach and the Roux limb lumens should also be visually inspected, although access to both may be challenging. Endoscopy or enteroscopy may need to be used [72]. A surgical gastrostomy may be needed for unsuccessful attempts at accessing the excluded stomach [73].
Endoscopic Retrograde Cholangiopancreatography (ERCP) After RYGB
Performing an ERCP in a post-RYGB patient presents a unique set of challenges. A standard endoscope cannot traverse the entire length of a Roux limb and thus cannot reach the duodenal papillae [74]. Choledocholithiasis can be diagnosed through non­endoscopic modalities such as MRCP or percutaneous transhe­patic cholangiography. There have been case reports of successful ERCPs using colonoscopes, double-balloon enteroscopy, single balloon enteroscopy, and spiral-assisted enteroscopy [75–77]. Minimally invasive laparoscopic transgastric ERCP can be per­formed as well, with success rates greater than with enteroscopy alone [78–80]. Retrograde ERCP can also be performed through an enterotomy in the Roux limb [81].
Conclusion
Upper gastrointestinal endoscopy is an essential tool in the diag­nosis and treatment of bariatric surgery patients. Preoperatively endoscopy is used to evaluate pathology that may alter the surgi­cal planning, yet routine and liberal use remains a subject of debate. Intraoperatively, endoscopy could be used with the proper indication and concerns to address any technical matters or com­plications promptly. Endoscopy might require expert skills when
224
https://t.me/medicina_free
S. El Djouzi
it comes to managing postoperative complications. As technology evolves, gastrointestinal endoscopy will likely gain an even more prominent role in the care of the bariatric patient.
Editors’ Note
See Figs.16.1, 16.2, 16.3, and 16.4.
Fig. 16.1 Endoscopic views in a patient after Roux-en-Y gastric bypass. Important factors to note include the length of the pouch, the size of the outlet of the pouch (in scope diameters), and the presence/absence of a hiatal hernia. The LES can also be examined to subjectively determine whether it is patu­lous. Finally, the scope should be passed as distally as possible in the roux limb to determine length (if the jejunojejunostomy can be reached) and there should be no bile in the roux limb
16 Endoscopic Evaluation oftheBariatric Surgery Patient
https://t.me/medicina_free
225
Fig. 16.2 Another patient’s upper endoscopy after a gastric bypass. This patient had a hiatal hernia, a normal outlet size at the gastrojejunostomy. However, the roux limb was noted to be short at 50cm and bile seen at the jejunojejunostomy as expected
226
a
b
https://t.me/medicina_free
S. El Djouzi
Fig. 16.3 Endoscopy after a gastric banding. The size of the pouch is very important from the gastroesophageal junction to the band. An excessive amount of stomach above the band is considered a slip. Also, a retroexed view beyond the band can be helpful to identify erosions. (a) Retroexed view showing band in place with no erosion. (b) Food in esophagus after band placed suggesting band to tight. Band in place with no erosion
a
16 Endoscopic Evaluation oftheBariatric Surgery Patient
https://t.me/medicina_free
227
b
Fig. 16.4 Endoscopy after vertical sleeve gastrectomy. (a) The sleeve should be tubular proximally and have a reasonable view through the incisura into the distal stomach where the staple line ends 5–7cm proximal to the pylorus. Retroexion in the distal stomach shows an open incisura as in panel 12. Retroexion in the proximal stomach can be difcult in tighter sleeves. (b). In panel 7, the incisura tightly holds the scope on retroexion. This is an unde­sirable nding on endoscopy in a sleeve. In panels 14 and 15, one can see a hiatal hernia and patulous LES, which can contribute to reux after a sleeve
References
1. Lee JK, Van Dam J, Morton JM, etal. Endoscopy is accurate, safe, effec­tive in the assessment and management of complications following gas­tric bypass surgery. Am J Gastroenterol. 2009;104:575–82.
228
https://t.me/medicina_free
2. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011;114:495.
3. ASGE Standards of Practice Committee, Khashab MA, Chithadi KV, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2015;81:81.
4. ASGE Standards of Practice Committee, Acosta RD, Abraham NS, etal. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3.
5. Stellato TA, Crouse C, Hallowell PT. Bariatric surgery: creating new challenges for the endoscopist. Gastrointest Endosc. 2003;57:86.
6. Sinar DR, Flickinger EG, Park HK, Sloss RR.Retrograde endoscopy of the bypassed stomach segment after gastric bypass surgery: unexpected lesions. South Med J. 1985;78:255.
7. Moreels TG, Hubens GJ, Ysebaert DK, etal. Diagnostic and therapeutic double-balloon enteroscopy after small bowel Roux-en-Y reconstructive surgery. Digestion. 2009;80:141.
8. Kilic ET, Sayar S, Kahraman R, Ozdil K. The effects of obesity on sedation- related outcomes of advanced endoscopic procedures. North Clin Istanb. 2019;6(4):321–6.
9. Jirapinyo P, Kumar N, Thompson CC.Patients with Roux-en-Y gastric bypass require increased sedation during upper endoscopy. Clin Gastroenterol Hepatol. 2015;13(8):1432–6.
10. Das S, Ghosh S.Monitored anesthesia care: an overview. J Anaesthesiol Clin Pharmacol. 2015;31:27–9.
11. Jirapinyo P, Abu Dayyeh BK, Thompson CC. Conscious sedation for upper endoscopy in the gastric bypass patient: prevalence of cardiopul­monary adverse events and predictors of sedation requirement. Dig Dis Sci. 2014;59(9):2173–7.
12. Sharma VK, Nguyen CC, Crowell MD, etal. Cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc. 2007;66:27–34.
13. Hampel H, Abraham NS, El-Serag HB.Meta-analysis: obesity and the risk for gastroesophageal reux disease and its complications. Ann Intern Med. 2005;143:199–211.
14. Abd Ellatif ME, Alfalah H, Asker WA, etal. Place of upper endoscopy before and after bariatric surgery: a multicenter experience with 3219 patients. World J Gastrointest Endosc. 2016;8(10):409–17.
15. Parikh M, Liu J, Vieira D, etal. Preoperative endoscopy prior to bariatric surgery: a systematic review and meta-analysis of the literature. Obes Surg. 2016;26:2961–6.
S. El Djouzi
16 Endoscopic Evaluation oftheBariatric Surgery Patient
https://t.me/medicina_free
16. Lee J, Wong SK, Liu SY, Ng EK.Is preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery mandatory? An Asian perspective. Obes Surg. 2017 Jan;27(1):44–50.
17. Saarinen T, Kettunen U, Pietiläinen KH, etal. Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass? Surg Obes Relat Dis. 2018;14:757–62.
18. Salama A, Saafan T, El Ansari W, etal. Is routine preoperative esophago­gastroduodenoscopy screening necessary prior to laparoscopic sleeve gastrectomy? Review of 1555 cases and comparison with current litera­ture. Obes Surg. 2018;28:52–60.
19. Genco A, Soricelli E, Casella G, etal. Gastroesophageal reux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possi­ble, underestimated long-term complication. Surg Obes Relat Dis. 2017;13:568–74.
20. Sebastianelli L, Benois M, Vanbiervliet G, etal. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esopha­gus: results of a multicenter study. Obes Surg. 2019;29:1462–9.
21. Dolan K, Finch R, Fielding G.Laparoscopic gastric banding and crural repair in the obese patient with a hiatal hernia. Obes Surg. 2003;13:772–
5.
22. ASGE Standards of Practice Committee, Evans JA, Muthusamy VR, etal. The role of endoscopy in the bariatric surgery patient. Surg Obes Relat Dis. 2015;11:507–17.
23. Haddad A, Tapazoglou N, Singh K, etal. Role of intraoperative esopha­gogastroenteroscopy in minimizing gastrojejunostomy-related morbid­ity: experience with 2,311 laparoscopic gastric bypasses with linear stapler anastomosis. Obes Surg. 2012;22:1928–33.
24. Champion JK, Hunt T, DeLisle N.Role of routine intraoperative endos­copy in laparoscopic bariatric surgery. Surg Endosc. 2002;16:1663–5.
25. Nimeri A, Maasher A, Salim E, etal. The use of intraoperative endoscopy may decrease postoperative stenosis in laparoscopic sleeve gastrectomy. Obes Surg. 2016;26:1398–401.
26. Stefanidis D, Navarro F, Augenstein VA, etal. Laparoscopic fundoplica­tion takedown with conversion to Roux-en-Y gastric bypass leads to excellent reux control and quality of life after fundoplication failure. Surg Endosc. 2012;26:3521–7.
27. Kim M, Navarro F, Eruchalu CN, Augenstein VA, Heniford BT, Stefanidis D.Minimally invasive Roux-en-Y gastric bypass for fundoplication fail­ure offers excellent gastroesophageal reux control. Am Surg. 2014;80(7):696–703.
28. Soricelli E, Iossa A, Casella G, etal. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reux disease and/or hiatal her­nia. Surg Obes Relat Dis. 2013;9:356–61.
29. Singh M, Lee J, Gupta N, etal. Weight loss can lead to resolution of gas­troesophageal reux disease symptoms: a prospective intervention trial.
229
230
https://t.me/medicina_free
Obesity (Silver Spring). 2013;21(2):284–90. https://doi.org/10.1002/
oby.20279.
30. Singhal R, Bryant C, Kitchen M, etal. Band slippage and erosion after laparoscopic gastric banding: a meta-analysis. Surg Endosc. 2010;24:2980–6.
31. El Djouzi S.Role of endoscopy in managing foreign body erosions after bariatric surgery. In: Chand B, editor. Endoscopy in obesity management. Cham: Springer; 2018. https://doi.org/10.1007/978- 3- 319- 63528- 6_10.
32. Foletto M, De Marchi F, Bernante P, et al. Late gastric pouch necrosis after Lap-Band, treated by an individualized conservative approach. Obes Surg. 2005;15:1487–90.
33. Iannelli A, Facchiano E, Sejor E, etal. Gastric necrosis: a rare complica­tion of gastric banding. Obes Surg. 2005;15:1211–4.
34. Azagury DE, Abu Dayyeh BK, Greenwalt IT, etal. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 2011;43:950–4.
35. El-Hayek K, Timratana P, Shimizu H, et al. Marginal ulcer after Roux­en- Y gastric bypass: what have we really learned? Surg Endosc. 2012;26:2789–96.
36. Wilson JA, Romagnuolo J, Byrne TK, et al. Predictors of endoscopic ndings after Roux-en-Y gastric bypass. Am J Gastroenterol. 2006;101:2194–9.
37. MacLean LD, Rhode BM, Nohr C, etal. Stomal ulcer after gastric bypass. J Am Coll Surg. 1997;185:1–7.
38. Marcotte E.Treatment of marginal ulcers after gastric bypass. In: Chand B, editor. Endoscopy in obesity management. Cham: Springer; 2018.
39. Carrodeguas L, Szomstein S, Soto F, etal. Management of gastrogastric stulas after divided Roux-en-Y gastric bypass surgery for morbid obe­sity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1:467–74.
40. Filho AJ, Kondo W, Nassif LS, etal. Gastrogastric stula: a possible com­plication of Roux-en-Y gastric bypass. JSLS. 2006;10:326–31.
41. Gould JC, Garren MJ, Starling JR. Lessons learned from the rst 100 cases in a new minimally invasive bariatric surgery program. Obes Surg. 2004;14:618–25.
42. Gumbs AA, Duffy AJ, Bell RL.Management of gastrogastric stula after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2:117–21.
43. Carucci LR, Turner MA, Conklin RC, etal. Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology. 2006;238:119–27.
44. Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M.Management of anastomotic leaks after laparoscopic Roux-en-Y gas­tric bypass. Obes Surg. 2008 Jun;18(6):623–30.
S. El Djouzi
16 Endoscopic Evaluation oftheBariatric Surgery Patient
https://t.me/medicina_free
45. Aurora AR, Khaitan L, Saber AA.Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.
46. Eisendrath P, Cremer M, Himpens J, etal. Endotherapy including tempo­rary stenting of stulas of the upper gastrointestinal tract after laparo­scopic bariatric surgery. Endoscopy. 2007;39:625–30.
47. Merrield BF, Lautz D, Thompson CC. Endoscopic repair of gastric leaks after Roux-en-Y gastric bypass: a less invasive approach. Gastrointest Endosc. 2006;63:710–4.
48. Brolin RE, Lin JM.Treatment of gastric leaks after Roux-en-Y gastric bypass: a paradigm shift. Surg Obes Relat Dis. 2013;9:229–33.
49. Spyropoulos C, Argentou MI, Petsas T, etal. Management of gastrointes­tinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis. 2012;8:609–15.
50. Evans JA, Branch MS, Pryor AD, etal. Endoscopic closure of a gastro­jejunal anastomotic leak (with video). Gastrointest Endosc. 2007;66:1225–6.
51. Papavramidis ST, Eleftheriadis EE, Papavramidis TS, etal. Endoscopic management of gastrocutaneous stula after bariatric surgery by using a brin sealant. Gastrointest Endosc. 2004;59:296–300.
52. Fukumoto R, Orlina J, McGinty J, etal. Use of Polyex stents in treat­ment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis. 2007;3:68–71; discussion 71–2.
53. Kriwanek S, Ott N, Ali-Abdullah S, etal. Treatment of gastro-jejunal leakage and stulization after gastric bypass with coated self expanding stents. Obes Surg. 2006;16:1669–74.
54. Salinas A, Baptista A, Santiago E, etal. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2:570–2.
55. Tsai C, Kessler U, Steffen R, Merki H, Zehetner J.Endoscopic closure of gastro-gastric stula after gastric bypass: a technically feasible procedure but associated with low success rate. Obes Surg. 2019;29(1):23–7.
56. Messmer JM, Wolper JC, Sugerman HJ.Stomal disruption in gastric par­tition in morbid obesity (comparison of radiographic and endoscopic diagnosis). Am J Gastroenterol. 1984;79:603–5.
57. Escalona A, Devaud N, Boza C, Pérez G, Fernández J, Ibáñez L, Guzmán S. Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator. Surg Endosc. 2007 May;21(5):765–8.
58. Peife KJ, Shiels AJ, Azar R, etal. Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. Gastrointest Endosc. 2007;66:248–52.
59. Go MR, Muscarella P 2nd, Needleman BJ, et al. Endoscopic manage­ment of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc. 2004;18:56–9.
231
232
https://t.me/medicina_free
60. Hwang RF, Swartz DE, Felix EL.Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc. 2004;18:1631–5.
61. Wetter A. Role of endoscopy after Roux-en-Y gastric bypass surgery. Gastrointest Endosc. 2007;66:253–5.
62. Parikh A, Alley JB, Peterson RM, etal. Management options for symp­tomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc. 2012;26:738–46.
63. Ryou M, Mogabgab O, Lautz DB, etal. Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gas­tric bypass. Surg Obes Relat Dis. 2010;6:526–31.
64. Yu S, Jastrow K, Clapp B, etal. Foreign material erosion after laparo­scopic Roux-en-Y gastric bypass: ndings and treatment. Surg Endosc. 2007;21:1216–20.
65. Parameswaran R, Ferrando J, Sigurdsson A.Gastric bezoar complicating laparoscopic adjustable gastric banding with band slippage. Obes Surg. 2006;16:1683–4.
66. Veronelli A, Ranieri R, Laneri M, etal. Gastric bezoars after adjustable gastric banding. Obes Surg. 2004;14:796–7.
67. Powers WF, Miles DR. Phytobezoar causing small bowel obstruction seven years after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7:e3–5.
68. Roy M, Fendrich I, Li J, etal. Treatment option in patient presenting with small bowel obstruction from phytobezoar at the jejunojejunal anastomo­sis after Roux-en-Y gastric bypass. Surg Laparosc Endosc Percutan Tech. 2012;22:e243–5.
69. Sarhan M, Shyamali B, Fakulujo A, etal. Jejunal bezoar causing obstruc­tion after laparoscopic Roux-en-Y gastric bypass. JSLS. 2010;14:592–5.
70. Pinto D, Carrodeguas L, Soto F, etal. Gastric bezoar after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16:365–8.
71. Nguyen NT, Longoria M, Chalifoux S, etal. Gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2004;14:1308–12.
72. Sakai P, Kuga R, Safatle-Ribeiro AV, et al. Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope. Endoscopy. 2005;37:566–9.
73. Sundbom M, Nyman R, Hedenstrom H, et al. Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obes Surg. 2001;11:25–7.
74. Baron TH, Chahal P, Ferreira LE.ERCP via mature feeding jejunostomy tube tract in a patient with Roux-en-Y anatomy (with video). Gastrointest Endosc. 2008;68:189.
75. Wright BE, Cass OW, Freeman ML.ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56:225–32.
S. El Djouzi
Соседние файлы в папке @xirurgi_2025
Помощь Обратная связь Вопросы и предложения Пользовательское соглашение Политика конфиденциальности