Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.

Imaging the postoperative patient: long-term complications of gastrointestinal surgery

OBJECTIVES

The objectives of this review are (1) to become acquainted with the long-term complications of surgery of the gastrointestinal tract, and (2) to appreciate the appropriate use of imaging in the assessment of long-term complications.

BACKGROUND

Gastrointestinal tract surgery comprises a group of procedures performed for a variety of both benign and malignant diseases. In the late postoperative setting, adhesions and internal hernias are the most important complications. and they can be further complicated by volvulus and ischemia. At present, computed tomography (CT) is the workhorse for evaluating late postoperative complications. Accurate imaging assessment of patients is essential for adequate treatment planning.

IMAGING FINDINGS OR PROCEDURE DETAILS

In this pictorial essay we will review the most frequent long-term complications after gastrointestinal surgery, including adhesions, afferent loop syndrome, closed-loop obstruction, strangulated obstruction, internal hernias, external hernias, anastomotic strictures and disease recurrence. Examples will be depicted using iconography from the authors' imaging department.

CONCLUSIONS

Knowledge of the most frequent complications after gastrointestinal surgery in the late postoperative period is of paramount importance for every radiologist, so that potentially life-threatening situations can be promptly diagnosed and adequate therapy can be planned.

TEACHING POINTS

• Long-term postoperative complications of gastrointestinal tract surgery can be divided into procedure-related and disease-related categories. • The most common procedure-related complications are internal hernias and adhesions. • The most frequent disease-related complications are mainly associated with neoplastic or inflammatory recurrence. • Computed tomography is the most useful examination when such complications are suspected.

Surgery for Severe Obesity

Bariatric surgery has been demonstrated to be an effective treatment for patients with severe obesity, producing improvements in many comorbid conditions, including type 2 diabetes, hypertension, obstructive sleep apnea, and dyslipidemia. The loss of body weight and resolution of comorbidities have been more recently found to be the result of functional and metabolic changes produced by the surgical procedures. Nonetheless, bariatric surgery is still considered to be a tool that is supported by health behaviors characteristic of all weight loss programs—that is, adoption of healthy eating patterns, engagement in robust physical activity, and implementation of constructive coping strategies. In addition, patients who undergo bariatric surgery face challenges that are particular to this population, including adjustment to rapid and significant reduction in body weight, forced alterations in eating behavior, and risk of alcohol misuse. This state-of-the-art review focuses on the research and resultant recommendations regarding lifestyle management for patients who have undergone bariatric surgery.