GASTROENTEROLOGY ARTICLE OF THE WEEK
May 1, 2003
Stellato TA, Crouse C, Hallowell PT. Bariatric surgery: creating new challenges for the endoscopist. Gastrointest Endosc 2003;57:86-94.
1. Currently, the most frequently performed operation for morbid obesity is
a. the jejunoileal bypass
b. vertical banded gastroplasty
c. laparoscopic adjustable silicone gastric banding
d. Roux-en-Y gastric bypass
2. Components of the Roux-en-Y gastric bypass operation that lead to weight loss include
a. small gastric pouch limiting intake
b. large gastric pouch-jejunal anastomosis opening provoking dumping syndrome
c. production of a sense of early satiety and loss of hunger
d. malabsorption by bypassing most of the small intestine
3. Nausea and vomiting after bariatric surgery
a. may be caused by stomal stenosis, which should never be dilated with
endoscopic balloons
b. persistence of inappropriate eating habits could be the cause
c. may lead to Wernicke’s encephalopathy particularly if associated with rapid
weight loss
True or False
4. The best management option for liver failure induced by JI bypass is immediate take down of the operation.
5. High volume lavage in preparation for colonoscopy should be avoided or used very carefully in patients who have undergone restrictive bariatric surgery procedures.
6. The vertical banded gastroplasty is designed to produce malabsorption.
7. The Roux-en-Y gastric bypass operation is purely a restrictive operation, it does not induce malabsorption.
8. A pouch to gastric fistula may be a cause of failure to lose weight after bariatric surgery.
9. The most important part of the endoscopic evaluation of a patients who have had bariatric surgery is to review the operative record prior to the endoscopy.
10. In RGB, the small gastric pouch produces acid, leading to erosive esophagitis.
11. The biliopancreatic diversion (BPD) surgery for morbid obesity:
a. has a blind loop that can lead to bacterial overgrowth
b. the original BPD surgery calls for a distal gastrectomy to be performed
c. the Roux limb used to deliver the biliary and pancreatic secretions to the intestine enters the small bowel 50cm proximal to the ICV
d. this operation achieves weight loss by a combination of restrictive and malabsorptive means.
A
B
C
D
E
12. Match the operation with the correct diagram (try not to look in the article!)
______ Vertical Banded Gastroplasty
______ Jejunoileal bypass
______ Adjustable silicone gastric band
______ Roux-en-Y gastric bypass
______ Biliopancreatic diversion