Guideline
Role of endoscopy in the bariatric surgery patient

https://doi.org/10.1016/j.gie.2008.01.028Get rights and content

Section snippets

Background

Obesity in the United States is a major health problem that contributes to increased morbidity and mortality and to a host of disease processes.1, 2 Body mass index (BMI) is calculated as weight/height2 (kg/m2) and is commonly used to classify overweight (BMI 25.0-29.9 kg/m2) and obese (BMI ≥30.0 kg/m2) adults. Based on data obtained from the National Health and Nutrition Examination Survey from 2003 to 2004, 61% of adults over the age of 20 years in the United States are overweight or obese,

Evaluation of the preoperative patient

The role of upper endoscopy in the preoperative evaluation of patients undergoing bariatric surgery may be based, in part, on the presence or absence of symptoms. The performance of an upper endoscopy in a patient with reflux symptoms, dysphagia, and/or dyspepsia has been covered in recent guidelines and is equally relevant in the preoperative patient.13, 14 However, because RYGB and DS/BPD render the distal stomach and/or duodenum inaccessible by a standard upper endoscope, the threshold for

General principles

When an endoscopy is considered in a patient who had bariatric surgery, the endoscopist should be aware of the operative procedure performed and the findings on preprocedural imaging studies, and must understand the expected anatomy, including the extent of resection and the length of surgically created limbs. Direct communication with the surgeon, if possible, is advisable. Feitoza and Baron26 published a detailed review of endoscopy in patients with postsurgical anatomy, including information

Symptoms

Nausea, vomiting, and abdominal pain are among the most commonly encountered symptoms after bariatric surgery and may result from one or several structural and functional etiologies. Symptoms are frequently associated with dietary noncompliance as to the volume and type of foods eaten, rapid ingestion, or inadequate chewing. Patients with persistent symptoms, despite counseling and behavior modification, should be evaluated, because these symptoms may indicate the development of marginal

Summary and recommendations

Bariatric surgical intervention presents new challenges to the endoscopist:

  • An upper endoscopy should be performed in all patients with upper-GI–tract symptoms who are to undergo bariatric surgery. (Level 2C)

  • Upper endoscopy should be considered in all patients who are to undergo an RYGB, regardless of the presence of symptoms. (Level 3)

  • In patients without symptoms and who are not undergoing an endoscopy, noninvasive H pylori testing followed by treatment, if positive, is recommended. (Level 3)

  • In

First page preview

First page preview
Click to open first page preview

References (108)

  • A. Salinas et al.

    Self-expandable metal stents to treat gastric leaks

    Surg Obes Relat Dis

    (2006)
  • R. Fukumoto et al.

    Use of Polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery

    Surg Obes Relat Dis

    (2007)
  • B.F. Merrifield et al.

    Endoscopic repair of gastric leaks after RYGB: a less invasive approach

    Gastrointest Endosc

    (2006)
  • L. Carrodeguas et al.

    Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients

    Surg Obes Relat Dis

    (2006)
  • K.J. Peifer et al.

    Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass

    Gastrointest Endosc

    (2007)
  • K.J. Peifer et al.

    Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass

    Gastrointest Endosc

    (2007)
  • A. Wetter

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

    Gastrointest Endosc

    (2007)
  • J.A. Evans et al.

    Endoscopic removal of eroded bands in vertical banded gastroplasty: a novel use of endoscopic scissors (with video)

    Gastrointest Endosc

    (2006)
  • L.A. Adam et al.

    Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty

    Gastrointest Endosc

    (2007)
  • R.D. Pai et al.

    Endoscopic evaluation of the defunctionalized stomach by using ShapeLock technology (with video)

    Gastrointest Endosc

    (2007)
  • G.M. Eisen et al.

    Use of endoscopy in diarrheal illnesses

    Gastrointest Endosc

    (2001)
  • L.J. Wudel et al.

    Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study

    J Surg Res

    (2002)
  • B.E. Wright et al.

    ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla

    Gastrointest Endosc

    (2002)
  • F.A. Ceppa et al.

    Laparoscopic transgastric endoscopy after RYGB

    Surg Obes Relat Dis

    (2007)
  • Overweight and obesity. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm. Accessed February 18,...
  • R.J. Kuczmarski et al.

    Varying body mass index cutoff points to describe overweight prevalence among U.S. adults: NHANES III (1988 to 1994)

    Obes Res

    (1997)
  • C.L. Ogden et al.

    Prevalence of overweight and obesity in the United States, 1999-2004

    JAMA

    (2006)
  • D.B. Allison et al.

    Annual deaths attributable to obesity in the United States

    JAMA

    (1999)
  • A. Must et al.

    The disease burden associated with overweight and obesity

    JAMA

    (1999)
  • E.E. Calle et al.

    Body-mass index and mortality in a prospective cohort of U.S. adults

    N Engl J Med

    (1999)
  • G.A. Bray

    The missing link: lose weight, live longer

    N Engl J Med

    (2007)
  • Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. National Institutes of Health

    Obes Res

    (1998)
  • H.P. Santry et al.

    Trends in bariatric surgical procedures

    JAMA

    (2005)
  • W.O. Griffen et al.

    The decline and fall of the jejunoileal bypass

    Surg Gynecol Obstet

    (1983)
  • H. Buchwald et al.

    Bariatric surgery worldwide 2003

    Obes Surg

    (2004)
  • H. Hampel et al.

    Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications

    Ann Intern Med

    (2005)
  • R.J. Greenstein et al.

    Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection

    Obes Surg

    (1998)
  • K. Dolan et al.

    Laparoscopic gastric banding and crural repair in the obese patient with a hiatal hernia

    Obes Surg

    (2003)
  • M. Korenkov et al.

    Is routine preoperative upper endoscopy in gastric banding patients really necessary?

    Obes Surg

    (2006)
  • T.M. Zeni et al.

    Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass

    Obes Surg

    (2006)
  • D. Verset et al.

    The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity

    Dig Dis Sci

    (1997)
  • R.N. Sharaf et al.

    Endoscopy plays an important preoperative role in bariatric surgery

    Obes Surg

    (2004)
  • B. Schirmer et al.

    Flexible endoscopy in the management of patients undergoing RYGB

    Obes Surg

    (2002)
  • S. Sauerland et al.

    European Association for Endoscopic Surgery. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES)

    Surg Endosc

    (2005)
  • A. Frigg et al.

    Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up

    Obes Surg

    (2001)
  • D. Azagury et al.

    Preoperative work-up in asymptomatic patients undergoing RYGB: is endoscopy mandatory?

    Obes Surg

    (2006)
  • E. Lattuada et al.

    Band erosion following gastric banding: how to treat it

    Obes Surg

    (2007)
  • J.A. Wilson et al.

    Predictors of endoscopic findings after Roux-en-Y gastric bypass

    Am J Gastroenterol

    (2006)
  • J.A. Sapala et al.

    Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients

    Obes Surg

    (1998)
  • L.G. Nelson et al.

    Amelioration of gastroesophageal reflux symptoms following RYGB for clinically significant obesity

    Am Surg

    (2005)
  • Cited by (0)

    This document is a product of the Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.

    This document was reviewed and endorsed by the SAGES Guidelines Committee and Board of Governors.

    View full text