GASTROENTEROLOGY ARTICLE OF THE WEEK
September 6, 2007
Elder KA, Wolfe BM. Bariatric surgery: A review of procedures and outcomes. Gastroenterology 2007;132:2253-2271.
1. Vertical banded gastroplasty
a. Is the procedure of choice for weight loss
b. Is associated with significant long-term weight loss
c. Can lead to gastric stricture, chronic vomiting and gastroesophageal reflux
d. Balloon dilation of the gastric stricture is the procedure of choice when symptoms occur
e. Asymptomatic band erosion identified during endoscopy requires immediate surgical correction
2. Comorbidities that are improved with successful bariatric surgery include
a. reduction in cancer risk
b. reduction in cardiovascular events
c. less infectious complications
d. less psychiatric and mental health problems
True or False
3. Bariatric surgery is associated with a 50% to 75% weight loss that is usually sustained for up to 16 years.
4. B12 deficiency is a common long-term complication of gastric bypass which requires administration of parenteral B12
5. To qualify for bariatric surgery, a patient must have a BMI of >40 or a BMI of 35-40 plus high-risk comorbidities
6. The alimentary limb of the gastric bypass procedure carries bile and pancreatic enzymes
7. Approximately 10% to 40% of patients undergoing bariatric surgery do not achive successful long-term weight loss.
8. Gastric bypass may suppress ghrelin secretion in response to fasting, decreasing hunger.
9. The typical gastrojejunal anastomosis should measure 1 to 2 cm in diameter
10. The classical biliopancreatic diversion includes a subtotal gastrectomy and the creation of a shorter alimentary limb than with gastric bypass, thus enhancing malabsorption
11. Iron deficiency is the most common micronutrient deficiency reported after bariatric surgery.
12. Laparoscopic adjustable gastric banding (LAGB) results in a faster initial weight loss than gastric bypass
13. Internal hernias are more common after bariatric surgery and can be easily identified by doing UGIS
14. Bariatric surgery leads to changes in neural and endocrine signals that affect appetite and satiety.
15. Men over age 60 are more likely to suffer from post-operative complications of bariatric surgery
16. The most common complications of LAGB is gastric slippage producing obstruction, vomiting and gastroesophageal regurgitation.
17. Anastomotic strictures can be endoscopically dilated to a diameter of 15-18mm, most anastomosis that are over 10mm in diameter do not need dilation.
18. Ursodiol therapy is recommended to prevent symptomatic cholelithiasis in patients that undergo bariatric surgery without cholecystectomy
19. Vomiting occurs in up to 79% of patients post-op and is often associated with psychiatric co-morbidities.