Bariatric Times - January 2009 - (Page 11)

Bariatric Times • January 2009 Surgical Perspective 11 FIGURES 9–11. Fig. 9: Silastic band eroding into gastric lumen after a Roux-en-Y gastric bypass. Fig. 10: A dual-channel therapeutic endoscope. Scope tip demonstrates the two (small and large) working channels. Fig. 11: Silicone foreign body retrieval hood. The hood flips to cover the scope tip and foreign body when pulled back across the gastroesophageal junction. Therapeutic endoscopy has become a very aggressive field, tackling difficult complications that would have not been performed in the past. That is not only due to the increased aggressiveness of the endoscopist but also to the improved available instrumentation. Stents, glues, clips, energy sources, and suturing devices have expanded the armamentarium to deal with these difficult problems. Although success of many of these endoscopic interventions may be limited in some cases, and no welldesigned studies have investigated the many offlabel uses of these tools, the ability to provide an intervention with little potential complication and potentially eliminate the need to reoperate on a complex bariatric patient is well worth it. Avoidance of reoperative bariatric surgery as well as the associated morbidity and mortality make endoscopic treatments appealing—not only to surgeons, but also to patients. As instrumentation continues to be developed for natural orifice translumenal endoscopic surgery (NOTES), many of these technologies will have dual application to be used intraluminally and subsequently expand the success and functionality of intraluminal surgery. These developing technologies will continue to assist in the endoscopic treatment of bariatric surgery complications. Bariatric surgeons need to either gain these skills sets or be aware of these newer options available for their patients. REFERENCES 1. 2. Sjostrom L, Linroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–2693. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: A systematic review and meta-analysis. JAMA. 2004;292:1724–1737. Maggard MA, Shugarman LR, Suttorp M et al. Meta-analysis: Surgical treatment of obesity. Ann Intern Med. 2005;142:547–559. Fernandez-Esparrach G, Bordas JM, Llach J, et al. Endoscopic dilation with Savary-Gilliard bougies of stomal stricures after laparoscopic gastric bypass in morbidly obese patients. Obes Surg. 2008;18:155–161. Mathew A, Veliuona MA, Depalma FJ, Cooney 3. 4. 5. http://www.carecredit.com http://www.carecredit.com

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Bariatric Times - January 2009

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