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- W2013079704 abstract "Introduction: Bariatric surgery represents a good option for the management of morbid obesity and associated co-morbidities. Therapeutic options include gastroplasty, banding and gastric bypass. Patients may develop post-surgical complications that are amenable to endoscopic management. Patients and Methods: A total of 107 pts were identified. These represented 9.4% of all pts who had undergone bariatric surgery (107/1137). There were 61 women and 46 men. Mean age was 39 years. Ten pts were hospitalized, 97 were ambulatory. There were 49 pts with gastrojejunal anastomotic stricture, 25 with pre-anastomotic bezoar without stenosis, 18 with penetrated silastic rings, 8 with fistula formation, 3 with gastrointestinal bleeding from marginal ulceration, and 4 with penetrated rigid bands. All had dysphagia, epigastric pain, nausea and emesis. The three pts with gastrointestinal bleeding also had associated melena. Three pts with fistula had sepsis. Two pts with bezoar had dehydration. The mean time from surgery to clinical presentation was 2 months (2 days-18 months). Endoscopic management included progressive hydrostatic balloon dilatation in 74 pts, ring removal in 22, injection therapy in 3, coated metallic stent placement in 8. Results: Balloon dilatation was successful in 47 of 49 (96%); Repeat dilatation was needed in pts in whom the initial dilatation was to 10 mm: after 15-18 mm dilatation no further intervention was needed. Silastic and rigid rings were removed in 21 of 22 pts (95%); the failed patient required surgery; fistulas closed in 8 of 8 pts (100%) with self-expandable coated stents. Of these, 6 have been removed endoscopically without fistula recurrence. Stent removal was very difficult in all regardless of timing to removal. Hemostasis was achieved in 3 of 3 patients (100%) with injection therapy. The only procedure related complication included an esophageal tear during stent removal treated medically. After a mean follow up of 13 months, there has been no recurrence of disease or symptoms. Conclusions: 1) Endoscopic management of bariatric surgery-related complications is a new challenge for endoscopists; 2) Endoscopic management of these complications is highly successful; 3) Close interaction between the endoscopist and the bariatric surgeon is mandatory to optimize management; 4) Knowledge of the “new” post-surgical anatomy is important to provide best possible therapy; 5) A larger number of pts and longer follow up is needed." @default.
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- W2013079704 date "2005-04-01" @default.
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- W2013079704 title "Endoscopic Management of Complications After Bariatric Surgery" @default.
- W2013079704 doi "https://doi.org/10.1016/s0016-5107(05)00888-6" @default.
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