Review ArticleBariatric surgery: Creating new challenges for the endoscopist☆,☆☆
Section snippets
The magnitude of the problem of obesity
Current-day references to obesity in the United States continually evoke the emotionally charged terms “epidemic” and “crisis.” “Obesity in the United States is a national health-care crisis…,”1 “…overweight and obesity have reached nationwide epidemic proportions….”2 “Epidemic Increase in Childhood Overweight, 1986-1998”3 and “The Continuing Epidemics of Obesity and Diabetes in the United States”4 are singular examples from a myriad of publications not isolated to the medical literature.
The evolution of bariatric operations
When called upon to evaluate the postoperative bariatric patient, the GI endoscopist will be confronted not only with diseases foreign to the nonbariatric patient but also new anatomy. One of the most comprehensive ways for the gastroenterologist to understand the altered anatomy found in the bariatric surgical patient is through an understanding of the evolution of surgical procedures for the treatment of obesity. This history now spans 5 decades.
Although bariatric surgical procedures have
Endoscopic evaluation of the postoperative bariatric patient
The endoscopist must observe certain basic principles before initiating an endoscopic procedure in the bariatric surgical patient. These are similar to those outlined by Feitoza and Baron38 in guiding the endoscopist in the setting of previous upper GI tract surgery, although with some important modifications. The following steps will be helpful to ensure success as well as minimize morbidity.
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Whenever possible, discuss the bariatric operation with the patient's surgeon. Modifications of
Conclusion
Obesity in the United States is a major health crisis affecting both adults and children. Surgical intervention is highly effective in select patients but creates challenges in the endoscopic evaluation of these patients. The excluded stomach after Roux-en-Y gastric bypass is accessible by only the most creative and challenging maneuvers. An understanding of the postoperative anatomy, an awareness of the possible operative complications, communication whenever possible with the bariatric
References (62)
- et al.
Surgical treatment of obesity: who is an appropriate candidate?
Mayo Clin Proc
(1997) - et al.
Metabolic observations in patients with jejunocolic shunts
Am J Surg
(1963) - et al.
Surgical treatment of obesity
Am J Surg
(1969) - et al.
Gastric bypass in obesity
Surg Clin North Am
(1967) Vertical banded gastroplasty
Surg Clin North Am
(2001)- et al.
Laparoscopic surgery for morbid obesity
Surg Clin North Am
(2001) - et al.
Endoscopic vertical band Gastroplasty with an endoscopic sewing machine
Gastrointest Endosc
(2002) Laparoscopic adjustable silicone gastric banding
Surg Clin North Am
(2001)- et al.
Results of the surgical treatment of obesity
Am J Surg
(1993) - et al.
Malabsorptive procedures for severe obesity: comparison of pancreaticobiliary bypass and very very long limb Roux-en-Y gastric bypass
J Gastrointest Surg
(1999)
Malabsorptive obesity surgery
Surg Clin North Am
Comparison of the cost associated with medical and surgical treatment of obesity
Surgery
Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part I: Reconstruction without alteration of pancreaticobiliary anatomy [review article]
Gastrointest Endosc
Complications of surgery for obesity
Surg Clin North Am
Effect of gastric bypass on gastric secretion
Am J Surg
ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla
Gastrointest Endosc
Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP
Gastrointest Endosc
Low-volume oral colonoscopy bowel preparation: sodium phosphate and magnesium citrate
Gastrointest Endosc
The surgeon-general's call to action to prevent an increase in overweight and obesity
Obes Surg
Epidemic increase in childhood overweight, 1986-1998
JAMA
The continuing epidemics of obesity and diabetes in the United States
JAMA
Obesity in perspective: a conference. John E Fogarty International Center for advanced study in the health sciences
Obesity in America. An overview of the Second Fogarty International Center conference on obesity
Int J Obes
Health implications of obesity. National Institutes of Health Consensus Development Conference Statement
Ann Intern Med.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The Evidence Report
Varying body mass index cutoff points to describe overweight prevalence among US adults: NHANES III(1988-1994)
Obes Res
Body-mass index and mortality in a prospective cohort of U.S. adults
N Engl J Med
Increasing pediatric obesity in the United States
Am J Dis Child
The spread of the obesity epidemic in the United States, 1991-1998
JAMA
Experimental evaluation of the nutritional importance of proximal and distal small intestine
Ann Surg
Intestinal bypass surgery for morbid obesity
JAMA
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2011, Clinical Gastrointestinal Endoscopy, Second Edition
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Reprint requests: Thomas A. Stellato, MD, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, Ohio 44106.
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