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World J Gastroenterol. Jan 14, 2022; 28(2): 199-215
Published online Jan 14, 2022. doi: 10.3748/wjg.v28.i2.199
Therapeutic endoscopy for the treatment of post-bariatric surgery complications
Michael Larsen, Richard Kozarek
Michael Larsen, Richard Kozarek, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Larsen M reviewed the literature and prepared the manuscript; Kozarek R contributed to and revised the manuscript; all authors approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Michael Larsen, MD, Doctor, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, United States. michael.larsen@virginiamason.org
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: June 13, 2021
Revised: July 8, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: January 14, 2022
Abstract

Obesity rates continue to climb worldwide. Obesity often contributes to other comorbidities such as type 2 diabetes, hypertension, heart disease and is a known risk factor for many malignancies. Bariatric surgeries are by far the most invasive treatment options available but are often the most effective and can result in profound, durable weight loss with improvement in or resolution of weight associated comorbidities. Currently performed bariatric surgeries include Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding. These surgeries are associated with significant weight loss, but also with significant rates of major complications. The complexity of these patients and surgical anatomies makes management of these complications by a multidisciplinary team critical for optimal outcomes. Minimally invasive treatments for complications are typically preferred because of the high risk associated with repeat operations. Endoscopy plays a large role in both the diagnosis and the management of complications. Endoscopy can provide therapeutic interventions for many bariatric surgical complications including anastomotic strictures, anastomotic leaks, choledocholithiasis, sleeve stenosis, weight regain, and eroded bands. Endoscopists should be familiar with the various surgical anatomies as well as the various therapeutic options available. This review article serves to delineate the current role of endoscopy in the management of complications after bariatric surgery.

Keywords: Therapeutic endoscopy, Bariatric surgery, Complications, Weight regain, Sleeve stenosis, Sleeve leak

Core Tip: Bariatric surgery is the most effective treatment for morbid obesity. While surgical techniques have improved, complications after these surgeries remain common. Multidisciplinary management of these complications is important given their complexity. Therapeutic endoscopy provides a minimally invasive option for treatment of complications. This review article serves to delineate the current role of therapeutic endoscopy in the management of complications after bariatric surgery.