What to Expect in the Excluded Stomach Mucosa After Vertical Banded Roux-en-Y Gastric Bypass for Morbid Obesity (original) (raw)
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Techniques in Gastrointestinal Endoscopy, 2008
The double balloon endoscope was initially devised for the endoscopic evaluation of small bowel diseases. However, the indications of its use have increased for patients with altered gastrointestinal anatomy after surgery because of its controlled capacity to reach the bypassed organs. One of these situations includes patients with Roux-en-Y gastric bypass, one of the most common surgical techniques performed for morbid obesity. In such patients, the bypassed stomach is inaccessible by conventional upper endoscopy, and the endoscopic and pathological changes of the bypassed stomach are unknown in a long-term period. Aside from common therapeutic procedures like hemostasis and polypectomy, the development of the endoscopic accessories allows the performance of other procedures, such as percutaneous endoscopic gastrostomy and endoscopic retrograde cholangiopancreatography, in such patients.
Endoscopic Findings in the Excluded Stomach After Roux-en-Y Gastric Bypass Surgery
Archives of Surgery, 2007
Hypothesis: After gastric bypass surgery performed because of morbid obesity, the excluded stomach can rarely be endoscopically examined. With the advent of a new apparatus and technique, possible mucosal changes can be routinely accessed and monitored, thus preventing potential benign and malignant complications. Design: Prospective observational study in a homogeneous population with nonspecific symptoms. Setting: Outpatient clinic of a large public academic hospital. Patients: Forty consecutive patients (mean ± SD age, 44.5 ± 10.0 years; 85.0% women) were seen at a mean±SD of 77.3 ± 19.4 months after Roux-en-Y gastric bypass surgery. Intervention: Elective double-balloon enteroscopy of the excluded stomach was performed. Main Outcome Measures: Rate of successful intubation, endoscopic findings, and complications. Results: The excluded stomach was reached in 35 of 40 patients (87.5%). Mean±SD time to enter the organ was 24.9±14.3 minutes (range, 5-75 minutes). Endoscopic find-ingswerenormalin9patients(25.7%),whereasin26(74.3%), varioustypesofgastritis(erythematous,erosive,hemorrhagic erosive, and atrophic) were identified, primarily in the gastric body and antrum. No cancer was documented in the present series. Tolerance was good, and no complications were recorded during or after the intervention. Conclusions: Thedouble-balloonmethodisusefulandpractical for access to the excluded stomach. Although cancer was not noted, most of the studied population had gastritis, including moderate and severe forms. Surveillance of the excluded stomach is recommended after Roux-en-Y gastric bypass surgery performed because of morbid obesity.
Endoscopic examination of the operated stomach: A Review and a systematic approach
Journal of Gastroenterology, 1994
The endoscopist examining a patient with a history of gastric surgery is expected to know details of the history, the present physical condition, and relevant laboratory results. Familiarity with the appropriateness or limitations of different types of fiberscopes in relation to the individual case, and knowledge of how to overcome common difficulties, is important. The preparation must address the particular characteristics of the case, and the endoscopist must be aware of contraindications, complications, and recommendations to be observed in special circumstances. Based on situations confronted in daily practice, the authors suggest a systematic approach to the examination of patients with a history of gastric surgery, and point to the importance of observing the following steps: measurement of the length of the greater curvature in the gastric stump, verification of artifacts and anatomic modifications and their repercussions, removal of symptomatic suture line or staples, dilatation of strictures, fragmentation of bezoars, exeresis of polypoid lesions, collection of tissue samples, and regular follow up of the patients.
Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass
Surgery for Obesity and Related Diseases, 2007
Endoscopic access to the gastric remnant and pancreatobiliary tree is technically difficult after Roux-en-Y gastric bypass even when facilitated by the use of specialized techniques such as balloon enteroscopy and the use of overtubes. Furthermore, such techniques are not universally available at all medical centers. We describe a case series of 13 patients with a history of Roux-en-Y gastric bypass for the treatment of morbid obesity who underwent laparoscopic transgastric endoscopy through the gastric remnant to access the duodenum or biliary tree. Charts of these patients were reviewed for demographics, indications for procedure, length of stay, morbidity, and mortality. Four of the patients had failed prior attempts to access the excluded anatomy through traditional transoral endoscopy. Two patients underwent transgastric endoscopy for evaluation of gastrointestinal bleeding. Of the 11 patients for whom endoscopic retrograde cholangiopancreatography was planned, all underwent successful biliary cannulation and sphincterotomy. There were no conversions to an open procedure or complications during the follow-up period. Laparoscopic transgastric endoscopy is a safe and reliable method to access the excluded stomach and biliary tree in patients with a history of Roux-en-Y gastric bypass.
Endoscopic innovations in gastric and pyloric disease
2021
Endoluminal surgery has innovated the management of foregut disorders including gastric motility disorders such as gastroparesis, upper gastrointestinal (GI) neoplasms including early-stage gastric cancer, gastric outlet obstruction, and management of post-operative foregut complications. Foregut pathologies that would have otherwise required abdominal incisions can now be successfully managed in the most minimally invasive available fashion. Intramural intervention, such as that used for per-oral pyloromyotomy (POP) which will be described here, has revolutionized the treatment of motility disorders of the foregut. Many aspects of the techniques described in this chapter share and build off of one another and several of the endoscopic instruments utilized are also shared across procedures. This is one of the many reasons endoluminal surgery has blossomed over the last two decades. To truly flourish as a foregut surgeon is to have the capability to perform the open, laparoscopic and...
Complications of Gastric Bypass: Avoiding the Roux-en-O Configuration
Obesity Surgery, 2009
Background Atypical complications of gastric bypass surgery include the Roux-en-O configuration: an improper connection of the bilio-pancreatic limb to the gastric pouch. Methods Four cases of Roux-en-O, which occurred at institutions not affiliated with the authors, were reviewed for issues related to causation and patient outcomes. Results One case was diagnosed intraoperatively (patient 1), while the time of diagnosis in the remaining three patients was postoperative days 2, 52, and 230 (patients 2-4). The delay resulted in two computed tomography scans, two endoscopies, and four contrast studies per patient. These patients presented with protracted biliary emesis and a clinical picture of bowel obstruction. Irrespective of time to diagnosis, all patients endured significant postoperative sequelae-numerous surgeries (n=10, 3, 1, and 3, respectively) and increased length of stay (97, 86, 49, and 125 days, respectively). Patients 2 and 3 were diagnosed by repeat laparotomy, and patient 4 was diagnosed by HIDA scan. Conclusions Nevertheless, surgery remains the most effective means by which to diagnose the problem, as well as correct the complication. Maneuvers that should be employed to prevent this rare complication include keeping the bilio-pancreatic limb short, identifying the ligament of Treitz and marking the Roux limb shortly after jejunal transection.
Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2012
Introduction -Roux-en-Y gastric bypass may result in stenosis of protocol for this complication. Aim -Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates. Methods -The PubMed database was searched for relevant for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded. Results -The mean age of the trial populations was 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain. Conclusion -Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should