41 Role of Flexible Endoscopy in the Practice of Bariatric Surgery

Flexible endoscopy is an increasingly valuable tool in managing bariatric surgery patients. Endoscopy is useful in the preoperative evaluation of patients—to identify upper gastrointestinal pathology, to determine anatomy, and to plan for revisional procedures. Intraoperatively, endoscopy is typically used to test for leaks at anastomoses and staple lines. In postsurgical patients, upper gastrointestinal symptoms can be evaluated and treated using flexible endoscopy. Common complications after bariatric surgery include marginal ulcers, strictures, bleeding, leaks/fistulas, band slippage or erosion, and weight regain. Endoscopy after certain bariatric procedures (e.g., gastric bypass) can be challenging due to the altered anatomy, but successful visualization, diagnosis, and treatment have been described. Furthermore, access to the biliopancreatic system after a gastric bypass can be achieved with specialized endoscopes and advanced maneuvers. Interventional applications for the treatment of postoperative complications consist of cautery or clipping for hemostasis, dilation for strictures, and stent placement for leaks and fistulas. The development of new endoscopic devices has broadened the applicability of endoscopy, and although largely investigational, includes volume reduction techniques, space-occupying devices, and malabsorptive devices.