title: Endoscopic management of bariatric surgical complications.
abstract: OBJECTIVE
  Bariatric surgery is recognized as the most effective treatment against obesity as it results in significant weight reduction and a high rate of remission of obesity-related comorbidities. However, bariatric surgery is not uncommonly associated with complications and an endoscopic approach to management is preferred over surgical reintervention. This review illustrates the latest developments in the endoscopic management of bariatric surgical complications.
  
  
  RESULTS
  For successful management of complications, precipitating and perpetuating factors must be addressed in addition to directing therapy at the target pathology. Endoscopy is well tolerated even in the acute postoperative setting when performed carefully with CO2 insufflation. Chronic proximal staple-line leaks/fistulas frequently do not respond to primary closure with diversion therapy, and a new technique of stricturotomy has been reported to improve outcomes. Innovations in the field of transoral endoscopic instruments have led to the development of a single-session entirely internal endoscopic retrograde cholangiopancreatography by creating a gastrogastric anastomosis.
  
  
  CONCLUSIONS
  Endoscopy allows for early diagnosis and prompt institution of therapy and should, therefore, be the first-line intervention in the management of complications of bariatric surgery in patients who do not need urgent surgical intervention. Computed tomography-guided drainage may be necessary in patients with drainable fluid collections.
  http://links.lww.com/COG/A11.
authors.affiliation: aDivision of Gastroenterology and Hepatology, Department of Medicine bDepartment of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.forename: Jennifer X
authors.initials: JX
authors.lastname: Cai
authors.forename: Michael A
authors.initials: MA
authors.lastname: Schweitzer
mesh_terms: D057868:Anastomotic Leak / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005402:Fistula / Q000601:surgery; D006801:Humans; D007327:Insufflation; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D013536:Suture Techniques; D014014:Tissue Adhesives; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives