Philadelphia-The number of people undergoing bariatric surgery continues to climb, and although expertise and refinement in the procedures may lead to less postoperative morbidity, the overall population of patients with complications is not small.
Once the realm of surgery, endoscopy is becoming a first-line approach to managing these complications and many, such as leaks and fistulas, can be repaired using skills common to all physicians trained in interventional gastroenterology.
"Most of us would agree that endoscopic management is reasonable to consider in early postoperative care; we want to avoid reoperating on these patients if possible," said Steven Edmundowicz, MD, professor of medicine and chief of endoscopy at Washington University Hospital, in St. Louis. Dr. Edmundowicz discussed the role of endoscopy in post-bariatric surgery complications at the 2014 annual meeting of the American College of Gastroenterology.
Early Complications
Leaks occur in as many as about 8% of bariatric surgery patients, Dr. Edmundowicz said, and present fairly early on-within one to two days for those caused by a mechanical disruption, five to seven days for those caused by tissue ischemia. Like any other approach in this situation, endoscopic intervention has a failure rate, "but it can be very effective and patients can recover rapidly and resume oral nutrition," he said.
Management of leaks begins with detection, usually with computed tomography (CT) imaging and oral
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