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Create a Free AccountProcedures - Bariatrics
Objective assessment of luminal diameter and distensibility by an impedance planimetry system before and after pneumatic dilation in gastric sleeve stenosis
Sleeve gastrectomy has increased in popularity in recent years. Despite its low adverse event rate, its increased prevalence has yielded an increase in the incidence of complications.1 One such complication is gastric sleeve stenosis (GSS), which occurs in up to 4% of patients, typically at the incisura.2 Depending on the severity of the stenosis, this complication commonly causes reflux, regurgitation, and obstructive symptoms such as nausea, vomiting, and abdominal pain.If at first you don’t succeed… a complicated course of endoscopic reversal of a gastric bypass
Marginal ulcer remains a common adverse event after Roux-en-Y gastric bypass (RYGB). Despite treatment with antisecretory therapy, up to a third of patients with recalcitrant ulcers may require surgical revision.1-4 In suboptimal surgical candidates or in patients who have failed attempts at surgical intervention, endoscopic techniques may be a preferable or required approach. Case reports have described uncomplicated endoscopic bypass reversal to treat refractory marginal ulcers.5 Here, we describe a more complicated, protracted case of a refractory marginal ulceration requiring endoscopic reversal, highlighting the potential for an oscillating, yet salvageable, approach (Video 1, available online at www.giejournal.org ).A unique twist following treatment of a sleeve gastrectomy leak: a multidisciplinary approach
Sleeve gastrectomy (SG) is currently the most common bariatric surgery procedure performed.1 GI leak is a known adverse event of SG, reported in up to 3% of patients,2 and is often the result of increased intraluminal pressure exceeding the strength of tissue and/or the staple line. Although there is a growing endoscopic armamentarium to manage these adverse events, refractory leaks often require surgical intervention.3-6 We describe a complex case of a leak after SG that, despite operative management, required a multidisciplinary approach involving endoscopic and surgical treatment strategies (Video 1, available online at www.giejournal.org ).Endoscopic sleeve gastroplasty: the “cable” technique
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure for the treatment of obesity whereby transmural sutures are placed to reduce gastric volume. An endoscopic suturing system (OverStitch, Apollo Endosurgery, Austin, Tex, USA) is used to create a running suture pattern that imbricates the greater curvature of the stomach, resulting in a reduction in functional volume by approximately 70%, in addition to 30% foreshortening.1-3Management of a refractory leak after sleeve gastrectomy: the endoscopic armamentarium
Leaks after sleeve gastrectomy are serious postoperative adverse events with significant morbidity. The timing of presentation and the chronicity of the leak affect management strategy, with acute/early (<6 weeks) leaks typically treated differently from late/chronic (>6-12 weeks) leaks.1,2 Ultimately, once a leak has matured and contains a fibrous septum, a septotomy may be necessary for definitive treatment. We present our approach to a refractory gastric sleeve leak managed with various endoscopic modalities.
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