Endoscopy after Roux-en-Y gastric bypass: a community hospital experience.
BACKGROUND
Roux-en-Y gastric bypass (RYGBP) is a common surgical intervention for morbid obesity. Postoperative GI symptoms are common. This study reports the endoscopic findings in symptomatic patients.


METHODS
Patients who developed GI symptoms after RYGBP at a single community hospital were referred for endoscopic evaluation. Standard endoscopic procedures using standard endoscopic equipment were used.


RESULTS
From April 2002 to April 2004, 23 out of 200 patients underwent 35 endoscopic procedures. All patients complained of some degree of epigastric pain, nausea and vomiting regardless of endoscopic findings. The most common endoscopic finding was ulcer disease (12 patients - 52%). Other findings included normal postoperative anatomy (7 patients - 30%), anastomotic stricture (1 patient - 4.3%), obstructed biliopancreatic limb (1 patient - 4.3%), acute gastric pouch bleed (1 patient - 4.3%), anastomotic rupture/dehiscence (1 patient - 4.3%). H. pylori was not detected in any patient.


CONCLUSIONS
In patients who have had RYGBP, symptoms were a poor predictor of endoscopic pathology. Ulcer disease was the most common endoscopic finding. These ulcers were not associated with H. pylori. All ulcers responded well to oral proton pump inhibitors (PPI) and sucralfate therapy. The community gastroenterologist should be acquainted with the typical post-surgical anatomy and possible endoscopic intervention for RYGBP patients.
Marano
Benjamin J
BJ
Department of Internal Medicine, Section of Gastroenterology, White Plains Hospital Center, White Plains, NY, USA. benmarano@optonline.net
D015746:Abdominal Pain / Q000175:diagnosis; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002779:Cholestasis / Q000175:diagnosis; D003251:Constriction, Pathologic / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis; D006764:Hospitals, Community; D006801:Humans; D007579:Jejunal Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010437:Peptic Ulcer / Q000175:diagnosis; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis; D012422:Rupture, Spontaneous; D013276:Stomach Ulcer / Q000175:diagnosis; D013529:Surgical Wound Dehiscence / Q000175:diagnosis