Review Article
Bariatric surgery: Creating new challenges for the endoscopist,☆☆

https://doi.org/10.1067/mge.2003.24Get rights and content

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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.

  • 1.

    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

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    Reprint requests: Thomas A. Stellato, MD, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, Ohio 44106.

    ☆☆

    0016-5107/2003/$30.00 + 0

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