Endoscopic management of post bariatric complications.pdf

Endoscopic management of post bariatric complications
Post sleeve leak
Post bariatric stenosis

3. • Obesity is associated with several chronic conditions including diabetes,
cardiovascular disease, and metabolic dysfunction-associated steatoticliver disease
and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and
sleeve gastrectomy, is an effective treatment modality for obesity and can improve
associated comorbidities.
• Over the last 20 years, there has been an increase in the rate of bariatric surgeries
associated with the growing obesity epidemic. Sleeve gastrectomyis the most
widely performed bariatric surgery currently, and while it serves as adurableoption
for some patients, it is important to note that several complications, including sleeve
leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastro esophageal
refluxdisease, may occur.
• Endoscopic methods to manage post-sleeve gastrectomy
complications are often considered due to the risks associated with a
reoperation, and endoscopy plays a significant role in the diagnosis
and management of post-sleeve gastrectomycomplications.

4. Gastric Sleeve Leak (GSL)
•mechanical factors
•tissue ischemia
first 2 days
>5–6 days

5. Gastric Sleeve Leak (GSL) classification
timinglocation severity
•Type I (subclinical)
Type II leaks (clinical)
timing
Early ( )intermediate ( ) late ( ).
clinicalradiologic
•Type A
•Type B
Type C

6. Gastric Sleeve Leak (GSL) Diagnosis
hemodynamically
unstable non-containedleaks

7. Gastric Sleeve Leak (GSL) Management
covered self-
expanding metal stents endoscopic internal drainage
over-the-scope clips endoscopic suturing
tissue sealant endoscopic vacuum septotomy

8. Endoscopic Stenting

9. Endoscopic Stenting

10. Endoscopic Stenting
drained
nasojejunalfeeding tube
MEGA

11. Endoscopic Internal Drainage with TransgastricDouble-Pigtail Stents

12. Endoscopic Internal Drainage with TransgastricDouble-Pigtail Stents
large
better tolerated
external drainage

13. Over-the-Scope Clips
large defects chronic fistulas

14. Endoscopic Suturing
poor ischemia infection

15. Endoscopic Tissue Sealant Application
fibrin glue cyanoacrylate
fibroblast proliferation
neovascularization

16. Endoscopic Vacuum Therapy
a percutaneous endoscopic jejunostomy nasojejunalfeeding
tube

17. Endoscopic Septotomy
knives scissorsargon plasma

18. Gastric Sleeve Stenosis
incisura
proximal sleeve leak

19. Endoscopic Balloon Dilation
narrow calibration tube Oversewing
abnormal rotation kinking
20 mm
30 mm
40
FCSEMS

20. Role of EndoluminalFunctional Lumen Imaging Probe
in the Diagnosis of Sleeve Stenosis
EndoFLIP gastric lumen
morphology

21. Gastric per-Oral Endoscopic Myotomyand
Endoscopic IntrapyloricBotulinumToxin Injections for
Gastric Sleeve Stenosis or Delayed Gastric Emptying
GPOEM
Botulinumtoxin

22. Gastrointestinal Bleeding

23. Gastrointestinal Bleeding
along the staple lineshort gastric trocar sites

24. ---Gastrointestinal Bleeding
thermocoagulation
injection therapy
mechanical
devices
American
Gastroenterological Association

25. GastroesophagealReflux Disease

26. GastroesophagealReflux Disease

27. GastroesophagealReflux Disease
esophagramesophageal manometry pH
testing

28. Post sleeve gastrectomycomplication

29. IN CONCLUSION
stenting internal drainage
through the-scope/over-the-scope clipssuturingtissue
sealantsendoscopic vacuum septotomy