Clinical Endoscopy

Reviews

Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control: Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura; Clin Endosc 2024;57(3):309-316. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.217

The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariatric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article comprehensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern exists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongoing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to support its routine use in clinical practice.

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Bacteroides and NAFLD: pathophysiology and therapy
Jun Zhang, Jing Zhou, Zheyun He, Hongshan Li
Frontiers in Microbiology.2024;[Epub] CrossRef

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Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review: Renato Medas, Eduardo Rodrigues-Pinto; Clin Endosc 2023;56(6):693-705. Published online July 3, 2023; DOI: https://doi.org/10.5946/ce.2023.043

Abstract PDF PubReader ePub: Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.

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Focused Review Series: Roleses of Bariatric Endoscopy in Obesity Treatment

Role of Endoscopic Gastroplasty Techniques in the Management of Obesity: Yunho Jung; Clin Endosc 2017;50(1):21-25. Published online January 30, 2017; DOI: https://doi.org/10.5946/ce.2016.147

Abstract PDF PubReader ePub

Health and wellness represent a major global concern. Trends such as a lack of exercise and excessive consumption of calories are major causes of the rapid increase in obesity worldwide. Obesity should be controlled because it can result in other illnesses, such as diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, breathing disorders, or cancer. However, many people have difficulty in managing obesity through exercise, dietary control, behavioral modifications, and drug therapy. Bariatric surgery is not commonly used due to a variety of complications, even though it has been demonstrated to produce reliable results with respect to adequate weight loss when performed using an open or a laparoscopic approach. Endoscopic bariatric procedures are emerging techniques that are less invasive and safer compared with current surgical approaches. However, the evaluation of endoluminal procedures is limited by the small number of studies and their short-term follow-up.

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Left gastric artery embolization for obesity treatment: a systematic review and meta-analysis of human and animal studies
Malkhaz Mizandari, Pedram Keshavarz, Tamta Azrumelashvili, Fereshteh Yazdanpanah, Elnaz Lorzadeh, Hamidreza Hosseinpour, Amir Bazyar, Seyed Faraz Nejati, Faranak Ebrahimian Sadabad
Abdominal Radiology.2021; 46(9): 4440. CrossRef
Bariatric Embolization of the Left Gastric Arteries for the Treatment of Obesity: 9-Month Data in 5 Patients
Zhi-Bin Bai, Yong-Lin Qin, Gang Deng, Guo-Feng Zhao, Bin-Yan Zhong, Gao-Jun Teng
Obesity Surgery.2018; 28(4): 907. CrossRef
Bariatric Arterial Embolization for Obesity: A Review of Early Clinical Evidence
Bin-Yan Zhong, Godwin Abiola, Clifford R. Weiss
CardioVascular and Interventional Radiology.2018; 41(11): 1639. CrossRef
Incidence of nausea and vomiting after intragastric balloon placement in bariatric patients – A systematic review and meta-analysis
Judy Trang, Seung Su Lee, Assia Miller, Christian X. Cruz Pico, Angelina Postoev, Isaac Ibikunle, Christopher Alade Ibikunle
International Journal of Surgery.2018; 57: 22. CrossRef

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Endoscopic Approach for Major Complications of Bariatric Surgery: Moon Kyung Joo; Clin Endosc 2017;50(1):31-41. Published online December 23, 2016; DOI: https://doi.org/10.5946/ce.2016.140

Abstract PDF PubReader ePub

As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.

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Advanced endolumenal management of acute and chronic leaks after bariatric surgery
Andrew R. Harner, Francisco Jr Guerra, Shinil K. Shah, Kulvinder S. Bajwa, Peter A. Walker, Erik B. Wilson, Melissa M. Felinski
Mini-invasive Surgery.2024;[Epub] CrossRef
Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy
Muaaz Masood, Donald E. Low, Shanley B. Deal, Richard A. Kozarek
Journal of Clinical Medicine.2024; 13(5): 1246. CrossRef
Endoscopic Management of Post-Sleeve Gastrectomy Complications
Muaaz Masood, Donald E. Low, Shanley B. Deal, Richard A. Kozarek
Journal of Clinical Medicine.2024; 13(7): 2011. CrossRef
A Systemic Review on Photodynamic Therapy: Emerging Technology with Healing Process
Prachi Varshney, Yogesh Kumar, Devdhar Yadav, Amit Singh, Naga Rani Kagithala, Pramod Kumar Sharma, Omji Porwal, Neeraj Kumar Fuloria, Pradeep Kumar Sharma, Ashok Kumar Gupta, G.S.N. Koteswara Rao
Current Cancer Therapy Reviews.2024; 20(3): 283. CrossRef
Endoscopic closure techniques of bariatric surgery complications: a meta-analysis
William N. Doyle, Alexander Netzley, Rahul Mhaskar, Abdul-Rahman F. Diab, Samer Ganam, Joseph Sujka, Christopher DuCoin, Salvatore Docimo
Surgical Endoscopy.2024; 38(5): 2894. CrossRef
Digestive neo-epithelialization after endoscopic stenting for upper digestive tract complete disunion
Sohaib Ouazzani, Arnaud Lemmers, Jean-Michel Gonzalez, Jean Closset, Imad El Moussaoui, Jacques Devière, Marc Barthet
Endoscopy.2024;[Epub] CrossRef
The Efficacy and Safety of Endoscopic Balloon Dilatation in the Treatment of Functional Post-Sleeve-Gastrectomy Stenosis
Mohamed A. Elsebaey, Mohamed Elsayed Enaba, Heba Elashry, Waleed Elrefaey, Rasha Youssef Hagag, Neveen A. Shalaby, Mohamed Sabry Aboelnasr, Mohamed Elsayed Sarhan, Omneya Mohamed Darrag, Assem Mohamed Elsokkary, Mohamed Abd Allah Alabd, Ahmed Mohamed El N
Medicina.2024; 60(5): 833. CrossRef
Bariatric Surgery Emergencies in Acute Care Surgery
Kalyana C. Nandipati, Kristin C. Bremer
Surgical Clinics of North America.2023; 103(6): 1113. CrossRef
Massive enlargement of gastric pouch as a complication of gastrojejunal anastomotic stenosis following one anastomosis laparoscopic gastric bypass: A case report
A. Martel-Vilchis, V. Gallardo-Chavez, P. León-Cabral, A. Paz-Fernández, E. Luna-Martinez, M. Sierra-Salazar
International Journal of Surgery Case Reports.2023; 110: 108557. CrossRef
Unexplained recurrent left lower lobe pneumonia, haematemesis and splenomegaly in a 32‐year‐old gentleman
Cynthuja Thilakanathan, Matthew Hall, Wassim Rahman, Mark Magdy, John Jorgensen
ANZ Journal of Surgery.2022; 92(1-2): 258. CrossRef
An innovative endoscopic management strategy for postoperative fistula after laparoscopic sleeve gastrectomy
Haiming Fang, Tingting Yao, Yating Chen, Yan Lu, Kangwei Xiong, Yuan Su, Yujue Zhang, Yong Wang, Lijiu Zhang
Surgical Endoscopy.2022; 36(9): 6439. CrossRef
Stent Management of Leaks After Bariatric Surgery: a Systematic Review and Meta-analysis
Andreu Martínez Hernández, Homero Beltrán Herrera, Vicente Martínez García, Miguel Ibáñez Belenguer, Raquel Queralt Martín, Ana Karina Maiocchi Segredo, Elena Aliaga Hilario, José Manuel Laguna Sastre
Obesity Surgery.2022; 32(4): 1034. CrossRef
Status of bariatric endoscopy–what does the surgeon need to know? A review
Diogo Turiani Hourneaux de Moura, Anna Carolina Batista Dantas, Igor Braga Ribeiro, Thomas R McCarty, Flávio Roberto Takeda, Marco Aurelio Santo, Sergio Carlos Nahas, Eduardo Guimarães Hourneaux de Moura
World Journal of Gastrointestinal Surgery.2022; 14(2): 185. CrossRef
Personalized Health Care Technology in Managing Postoperative Gastrointestinal Surgery Complications: Proof of Concept Study
Yaqeen Qudah, Mohammed Abdallah, Juan S. Barajas-Gamboa, Gabriel Diaz Del Gobbo, Juan Pablo Pantoja, Ricard Corcelles, John Rodriguez, Numan Balci, Matthew Kroh
Journal of Laparoendoscopic & Advanced Surgical Techniques.2022; 32(11): 1170. CrossRef
Role of Primary Use of Mega Stents Alone and Combined with Other Endoscopic Procedures for Early Leak and Stenosis After Bariatric Surgery, Single-Institution Experience
Mohamed Hany, Mohamed Ibrahim, Ahmed Zidan, Mohamed Samir, Amr Elsherif, Mohamed Selema, Mohamed Sharaan, Mohamed Elhashash
Obesity Surgery.2021; 31(5): 2050. CrossRef
A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks
Mihajlo Gjeorgjievski, Zaid Imam, Mitchell S. Cappell, Laith H. Jamil, Michel Kahaleh
Journal of Clinical Gastroenterology.2021; 55(7): 551. CrossRef
Foregut Issues After Bariatric Surgery
Fareed Cheema, Aurora D. Pryor
Foregut: The Journal of the American Foregut Society.2021; 1(4): 386. CrossRef
Endoscopic Stents in the Management of Bariatric Complications: Our Algorithm and Outcomes
Shyam Vedantam, Jay Roberts
Obesity Surgery.2020; 30(3): 1150. CrossRef
Mini gastric bypass for the management of gastrobronchial fistula: A case report
Abdulhamid Alharbi, Mohammed Alnaami, Abdulrahman Alsayyari, Mana Almuhaideb
International Journal of Surgery Case Reports.2020; 66: 192. CrossRef
Incidence and Efficacy of Stent Placement in Leak Management After Bariatric Surgery
Arielle E. Kanters, Sarah P. Shubeck, Oliver A. Varban, Justin B. Dimick, Dana A. Telem
Annals of Surgery.2020; 271(1): 134. CrossRef
Evolving procedural options for the treatment of obesity
Talar Tatarian, Kais A. Rona, Daniel H. Shin, Daniel G. Chen, Christopher G. Ducoin, Rachel L. Moore, Vitor O. Brunaldi, Manoel Galvão-Neto, Jessica Ardila-Gatas, Salvatore Docimo, Diogo T. Hourneax de Moura, Pichamol Jirapinyo, Christopher C. Thompson, H
Current Problems in Surgery.2020; 57(4): 100742. CrossRef
Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass
Fadi Younis, Mati Shnell, Nathan Gluck, Subhi Abu-Abeid, Shai Eldar, Sigal Fishman
BMC Surgery.2020;[Epub] CrossRef
Endoscopic balloon dilation for treatment of sleeve gastrectomy stenosis: a systematic review and meta-analysis
Steven H. Chang, Violeta B. Popov, Christopher C. Thompson
Gastrointestinal Endoscopy.2020; 91(5): 989. CrossRef
Long-term outcomes following endoscopic stenting in the management of leaks after foregut and bariatric surgery
Varun Krishnan, Kevin Hutchings, Andrew Godwin, Jonathan T. Wong, Julio Teixeira
Surgical Endoscopy.2019; 33(8): 2691. CrossRef
A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity
R Vilallonga, JL Pereira-Cunill, S Morales-Conde, I Alarcón, I Breton, E Domínguez-Adame, JV Ferrer, A Garcia Ruiz-de-Gordejuela, A Goday, A Lecube, E Martín García-Almenta, MÁ Rubio, FJ Tinahones, PP García-Luna
Obesity Surgery.2019; 29(12): 3842. CrossRef
Endoscopic Abscess Septotomy: A Less Invasive Approach for the Treatment of Sleeve Gastrectomy Leaks
Camila B. Ortega, Alfredo D. Guerron, Dana Portenier
Journal of Laparoendoscopic & Advanced Surgical Techniques.2018; 28(7): 859. CrossRef
Management of gastric fistula complicating laparoscopic sleeve gastrectomy with biological glue in a combined percutaneous and endoscopic approach
Ahmad Assalia, Anat Ilivitzki, Amos Ofer, Alain Suissa, Elias Manassa, Iyad Khamaysi, Ahmad Mahajna
Surgery for Obesity and Related Diseases.2018; 14(8): 1093. CrossRef
A Retrospective 2-Year Follow-up of Late Complications Treated Surgically and Endoscopically After Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) for Morbid Obesity
Mervi Javanainen, Anne Penttilä, Harri Mustonen, Anne Juuti, Tom Scheinin, Marja Leivonen
Obesity Surgery.2018; 28(4): 1055. CrossRef
Acute bleeding obstruction pancreatitis after Roux-en-Y anastomosis in total gastrectomy: a single center experience
J. Weindelmayer, S. Laiti, R. La Mendola, M. Bencivenga, L. Scorsone, V. Mengardo, S. Giacopuzzi
Updates in Surgery.2018; 70(2): 301. CrossRef
Management of Bariatric Complications Using Endoscopic Stents: a Multi-Center Study
Rena C. Moon, Andre F. Teixeira, Lyz Bezerra, Helga Cristina Almeida Wahnon Alhinho, Josemberg Campos, Luiz Gustavo de Quadros, Artagnan Menezes Barbosa de Amorim, Manoel Galvao Neto, Muhammad A. Jawad
Obesity Surgery.2018; 28(12): 4034. CrossRef
Endoscopic management of surgical complications
Robert J. Bowles-Cintron, Armando Perez-Ginnari, Jose M. Martinez
Techniques in Gastrointestinal Endoscopy.2018; 20(4): 182. CrossRef
A nutrition problem solved by a two-step endoscopic removal of a non-adjustable gastric band
Christer D Johansen, Jan Norum, Bernt E Engebretsen, Uwe Agledahl
Journal of Surgical Case Reports.2018;[Epub] CrossRef
Organization of future training in bariatric gastroenterology
Timothy R Koch, Timothy R Shope, Christopher J Gostout
World Journal of Gastroenterology.2017; 23(35): 6371. CrossRef

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Case Report

Asymptomatic Gastric Band Erosion Detected during Routine Gastroduodenoscopy: Gee Young Yun, Woo Sub Kim, Hye Jin Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong; Clin Endosc 2016;49(3):294-297. Published online February 11, 2016; DOI: https://doi.org/10.5946/ce.2016.001

Abstract PDF PubReader ePub

The incidence of gastric band erosion has decreased to 1%. Gastric band erosion can manifest with various clinical symptoms, although some patients remain asymptomatic. We present a case of a mostly asymptomatic patient who was diagnosed with gastric band erosion during a routine health check-up. A 32-year-old man without any underlying diseases except for non-alcoholic fatty liver underwent laparoscopic adjustable gastric band surgery in 2010. He had no significant complications postoperatively. He underwent routine health check-ups with near-normal gastroduodenoscopic findings through 2014. However, in 2015, routine gastroduodenoscopy showed that the gastric band had eroded into the stomach. His gastric band was removed laparoscopically, and the remaining gastric ulcer perforation was repaired using an omental patch. Due to the early diagnosis, the infection was not serious. The patient was discharged on postoperative day 3 with oral antibiotics. This patient was fortunately diagnosed early by virtue of a routine health check-up, thus eliminating the possibility of serious complications.

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Retrieval of Gastric Band Eroding Into the Stomach: A Gastrointestinal Fistula Case Managed Through a Combined Laparoscopic and Colonoscopic Approach
Ahmed Binjaloud , Ahad Alotaibi, Samar Alsubhi , Anfal Altamimi, Osamah Nafea, Zeyad Al Yousef
Cureus.2024;[Epub] CrossRef
Late-Onset Gastric Band Erosion Following Heavy Nonsteroidal Anti-inflammatory Drug Use
Zachary Makovich, Brijesh Patel
ACG Case Reports Journal.2024; 11(4): e01343. CrossRef
Management of Laparoscopic Adjustable Gastric Band Erosion: A Case Report
Taylor F Faust, Emma Schnittka, Michael B Steadman, Garrett M Cail, Bradley S Rice
Cureus.2023;[Epub] CrossRef
Complications from Laparoscopic Adjustable Gastric Banding: 364 Cases Experience
GV Ramiro
Global Journal of Obesity, Diabetes and Metabolic Syndrome.2017; 4(1): 001. CrossRef

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Obesity and Endoscopic Treatment: Sung Soo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(5):275-282. Published online May 28, 2011

Abstract PDF: Obese patients have been increasing with the development of a social economy. Obesity is a disease with high mortality rates due to associated cardiovascular disease and diabetes. Diet or exercise therapy, medications, bariatric surgery are used for treating obesity. However, although bariatric surgery is safe and effective, it is expensive, and reoperation is a burden if patients fail to lose weight. Operative complications are also a problem. The recent development of endoluminal techniques may permit obesity treatment and many endoscopic procedures have been attempted. The role of endoscopy for treating obesity is treating the postoperative complications of bariatric surgery, for example, a stricture or widening of the anastomosis, fistula, or leaks. Second, endoscopic applications could be used for weight reduction to temporarily bridge surgery for high-risk patients with obesity, and for reducing weight in patients unable to undergo surgery. This article provides a brief overview of bariatric surgery and its complications and introduces several endoscopic applications to treat obesity. (Korean J Gastrointest Endosc 2011;42:275-282)

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