Endoscopic management in the bariatric surgical patient

Purpose of review: Morbid obesity is a global health epidemic. As the prevalence of bariatric surgery rises, it becomes increasingly important for gastroenterologists to understand their role in the perioperative care of bariatric surgical patients, to recognize potential complications of surgery that can be addressed endoscopically, and to learn about endoluminal approaches that may provide alternatives to bariatric surgery in the future. Recent findinds: Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band account for more than 80% of weight loss procedures performed worldwide. Over two-thirds of patients with upper gastrointestinal symptoms following RYGB will have one or more abnormalities on endoscopy, including anastomotic strictures (53%), marginal ulcers (16%), functional obstructions (4%), and gastrogastric fistulas (2.6%). Intraoperative endoscopy can detect early leaks in over 7% of patients during RYGB surgery. Single-center experience finds that endoscopic repair of small gastrogastric fistulas is technically feasible in 95% of patients; however, durability of closure remains limited. Pooled data demonstrate that balloon-assisted endoscopic retrograde cholangiopancreatography can achieve papillary cannulation in 80% of patients with RYGB anatomy. Summary: The gastroenterologist can improve outcomes in bariatric surgical patients by understanding the issues of care that present themselves perioperatively and that lend themselves to minimally invasive endoscopic treatments.