GASTROENTEROLOGY ARTICLE OF THE WEEK
August 21, 2008
ASGE Guideline. Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2008;68:1-10.
1. You are performing an EGD on a patient who had an unknown type of bariatric surgery. Upon entering the gastric pouch and performing a difficult retroflexion against your attending’s advice, you encounter a 1cm stoma that leads to a normal appearing distal stomach and duodenum. You conclude that
a. You messed up and disrupted the suture line of a gastric bypass operation
b. A fistula has been created between the gastric pouch and the rest of the stomach
c. The patient had a vertical banded gastroplasty
d. The patient had a sleeve gastrectomy
2. Anastomotic stenosis after gastric bypass
a. is diagnosed if the lumen is <1cm
b. Cannot be dilated endoscopically
c. Can only be dilated with through the scope balloons
d. Dilation should be done to a size of 15mm
e. If the stricture is found distal to the anastomosis, endoscopic dilation should not be attempted
3. Marginal ulcers after gastric bypass
a. usually develop during the first week after surgery
b. Most commonly develop on the gastric side of the anastomosis
c. May represent ischemia
d. Are more common in patient who smoke and/or use NSAID’s
True or False
4. All patients should undergo EGD prior to bariatric surgery even in the absence of symptoms.
5. The presence of a large hiatal hernia is a relative contraindication to laparoscopic adjustable gastric banding
6. There is no role in using PPI’s in patients who have GERD symptoms after gastric bypass
7. Patients who are planning on undergoing bariatric surgery should be tested for H. pylori infection
8. Endoscopy is the test of choice to diagnose slippage of a gastric band
9. When performing an EGD on a patient who has an adjustable gastric band in place you should measure the length of the gastric pouch and assess for erosion of the band into the stomach