Background and Aims: As the prevalence of obesity continues to rise, increasing numbers of patients undergo bariatric surgery. Management of adverse events of bariatric surgery may be challenging and often requires a multidisciplinary approach. Endoscopic intervention is often the first line of therapy for management of these adverse events. This document reviews technologies and techniques used for endoscopic management of adverse events of bariatric surgery, organized by surgery type. Methods: The MEDLINE database was searched through May 2018 for articles related to endoscopic management of adverse events of bariatric interventions by using relevant keywords such as adverse events related to “gastric bypass,” “sleeve gastrectomy,” “laparoscopic adjustable banding,” and “vertical banded sleeve gastroplasty,” in addition to “endoscopic treatment” and “endoscopic management,” among others. Available data regarding efficacy, safety, and financial considerations are summarized. Results: Common adverse events of bariatric surgery include anastomotic ulcers, luminal stenoses, fistulae/leaks, and inadequate initial weight loss or weight regain. Devices used for endoscopic management of bariatric surgical adverse events include balloon dilators (hydrostatic, pneumatic), mechanical closure devices (clips, endoscopic suturing system, endoscopic plication platform), luminal stents (covered esophageal stents, lumen-apposing metal stents, plastic stents), and thermal therapy (argon plasma coagulation, needle-knives), among others. Available data, composed mainly of case series and retrospective cohort studies, support the primary role of endoscopic management. Multiple procedures and techniques are often required to achieve clinical success, and existing management algorithms are evolving. Conclusions: Endoscopy is a less invasive alternative for management of adverse events of bariatric surgery and for revisional procedures. Endoscopic procedures are frequently performed in the context of multidisciplinary management with bariatric surgeons and interventional radiologists. Treatment algorithms and standards of practice for endoscopic management will continue to be refined as new dedicated technology and data emerge.
Bibliographical noteFunding Information:
The following authors disclosed financial relationships: A. Schulman: Consultant for Boston Scientific, Apollo Endosurgery, and MicroTech; research support from GI Dynamics. R. Watson: Consultant for Apollo Endosurgery, Boston Scientific, Medtronic, and Neptune Medical Inc; speaker for Apollo Endosurgery and Boston Scientific. B. Abu Dayyeh: consultant for Metamodix, BFKW, DyaMx, and Boston Scientific; has received research support from Apollo Endosurgery, USGI, Spatz Medical, GI Dynamics, Cairn Diagnostics, Aspire Bariatrics, and Medtronic; and is a speaker for Johnson and Johnson, Endogastric Solutions, and Olympus. M. Bhutani: Research support from Silenseed Inc, Galera Inc, Oncosil Inc, and Augmenix Inc; food, beverage, or travel compensation from Boston Scientific, Augmentix, and Conmed Corporation. V. Chandrasekhara: Advisory board for Interpace Diagnostics; shareholder in Nevakar, Inc. P. Jirapinyo: Consultant for GI Dynamics and Endogastric Solutions; research support from GI Dynamics, Apollo Endosurgery, and Fractyl. K. Krishnan: Consultant for Olympus Medical. N. Kumta: Consultant for Boston Scientific, Olympus Corporation of the Americas, Gyrus ACMI, Inc, and Apollo Endosurgery US Inc. Abu Dayyeh: consultant for Metamodix, BFKW, DyaMx, and Boston Scientific; has received research support from Apollo Endosurgery, USGI, Spatz Medical, GI Dynamics, Cairn Diagnostics, Aspire Bariatrics, and Medtronic; and is a speaker for Johnson and Johnson, Endogastric Solutions, and Olympus. D. Lichtenstein: Consultant for Allergan Inc, Augmenix, Gyrus ACMI, Inc, and Olympus Corporation of the Americas; speaker for Aries Pharmaceutical, Gyrus ACMI, Inc, and Olympus Corporation of the Americas; tuition compensation from Erbe USA Inc. J. Melson: Research support from Boston Scientific; stock options with Virgo Imaging. R. Pannala: Consultant for HCL Technologies; travel compensation from Boston Scientific Corporation; stockholder in AbbVie. G. Trikudanathan: Speaker for and honorarium and travel compensation from Boston Scientific; advisory board for Abbvie. A. Trindade: Consultant for Olympus Corporation of the Americas and Pentax of America, Inc; food and beverage compensation from Boston Scientific; research support from NinePoint Medical, Inc.
© 2020 American Society for Gastrointestinal Endoscopy