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  • Review Article
  • Published:

Major complications of bariatric surgery: endoscopy as first-line treatment

Nature Reviews Gastroenterology & Hepatology volume 12, pages 701–710 (2015)Cite this article

Subjects

Key Points

  • Endoscopic techniques can be appropriate for the treatment of post-bariatric surgery complications including leakage, strictures, fistulas, bleeding and migrated bands or rings

  • Endoscopic management of post-bariatric surgery leakages can provide a safe and effective alternative to reintervention surgery

  • Self-expandable stent insertion is the most reported endoscopic method for management of post-bariatric surgery leakages with a success rate around 80%

  • Prospective studies are needed to define the best standards of care for endoscopic approaches in leakage management

  • Post-RYGB strictures can be resolved by one or more endoscopic dilation sessions

  • Band or ring endoscopic extraction is associated with reported success rates between 80% and 100%

Abstract

Leaks are the most frequent early postoperative complication in the two most popular bariatric procedures, Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy. Multimodal therapy based on self-expandable stent insertion 'to cover' the defect is the most widely documented technique to date with a reported success rate >80%. Additional experimental techniques 'to close' the defect or 'to drain' the paradigestive cavity have been reported with encouraging results. The role of endoscopy in early postoperative bleeding is limited to management of bleeds arising from fresh sutures and the diagnosis of chronic sources of bleeding such as marginal ulcer after RYGB. Post-RYGB stricture is a more delayed complication than leaks and the role of endoscopic dilation as a first-line treatment in this indication is well documented. Ring and band placement are outdated procedures for obesity treatment, but might still be an indication for endoscopic removal, a technique which does not compromise further surgery, if needed.

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Figure 1: Proposed therapeutic algorithm for post-bariatric surgery leaks.
Figure 2: Late post-sleeve gastrectomy leak and well-circumscribed collection treated by favouring internal drainage with two double pigtail stents.
Figure 3: Self-expanded metallic stent placed for post-LSG leak.
Figure 4: Endoscopic section and extraction of partially migrated laparoscopic gastric band.

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  1. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, B-1070, Belgium

    Pierre Eisendrath & Jacques Deviere

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  1. Pierre Eisendrath
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  2. Jacques Deviere
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P.E. researched data for the article. P.E. and J.D. contributed equally to discussion of content, writing, and reviewing and editing the manuscript before submission.

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Correspondence to Pierre Eisendrath.

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Eisendrath, P., Deviere, J. Major complications of bariatric surgery: endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol 12, 701–710 (2015). https://doi.org/10.1038/nrgastro.2015.151

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