Review
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World J Gastrointest Endosc. Mar 16, 2017; 9(3): 105-126
Published online Mar 16, 2017. doi: 10.4253/wjge.v9.i3.105
Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results
Raquel Souto-Rodríguez, María-Victoria Alvarez-Sánchez
Raquel Souto-Rodríguez, María-Victoria Alvarez-Sánchez, Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, 36071 Pontevedra, Spain
Author contributions: Souto-Rodríguez R and Alvarez-Sánchez MV contributed equally to reviewing the literature, writing and drafting the article, critical revision and final approval.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: María-Victoria Alvarez Sánchez, MD, Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, Avenida de Mourente s/n, 36071 Pontevedra, Spain. victoria.alvarez.sanchez@hotmail.com
Telephone: +34-986-800907 Fax: +34-986-800309
Received: September 3, 2016
Peer-review started: September 4, 2016
First decision: September 29, 2016
Revised: October 18, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: March 16, 2017
Abstract

Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

Keywords: Bariatric surgery, Bariatric complications, Endoscopic treatment, Leaks, Stenosis, Sleeve gastrectomy, Gastric Roux-en-Y bypass

Core tip: In developed countries obesity is a prevalent and rising problem. Bariatric surgery is the most effective treatment to obtain sustainable weight loss but postoperative complications may be serious and challenging to treat. The minimally-invasive character of endoscopic treatment has led endoscopic management of bariatric complications to become a suitable alternative to surgery. In this article, we discuss the indications of endoscopic treatment after bariatric surgery and the available endoscopic techniques.