Advances in the application of endoscopic techniques in postoperative complications after bariatric-metabolic surgery
10.7659/j.issn.1005-6947.250099
- VernacularTitle:内镜技术在减重代谢手术后并发症中的应用进展
- Author:
Yiqiao ZHANG
1
;
Yang LIU
1
;
Zhongtao ZHANG
1
Author Information
1. 首都医科大学附属北京友谊医院普通外科中心,北京 100050;消化健康全国重点实验室,北京 100050;国家消化系统疾病临床医学研究中心,北京 100050
- Publication Type:Journal Article
- Keywords:
Bariatric Surgery;
Obesity,Morbid;
Endoscopes;
Postoperative Complications
- From:
Chinese Journal of General Surgery
2025;34(4):614-624
- CountryChina
- Language:Chinese
-
Abstract:
Obesity,as a major global public health issue,has seen effective improvements in body weight and metabolic disorders through bariatric-metabolic surgeries such as Roux-en-Y gastric bypass(RYGB)and sleeve gastrectomy(SG).However,the management of postoperative complications remains a significant clinical challenge.Gastrointestinal leakage/fistula is one of the more severe complications,and current endoscopic treatment options include stent placement,double-pigtail stent internal drainage,over-the-scope clips,endoscopic suturing,tissue adhesive sealing,negative pressure drainage systems,and gastric wall incision.The combination with laparoscopic techniques can further enhance treatment efficacy.For SG-related torsion or stenosis,endoscopic balloon dilation is the first-line approach.In refractory cases,additional therapies such as endoscopic radial incision or modified gastric peroral endoscopic myotomy(G-POEM)may be required.G-POEM offers particular advantages in treating non-spiral stenosis but remains limited in practice due to technical complexity.Postoperative gastrointestinal bleeding requires stratified management:thermal coagulation or hemostatic clips can be used in acute bleeding;marginal ulcer bleeding at the gastrojejunostomy site after RYGB responds well to endoscopic treatment,while bleeding at the jejunojejunostomy site often requires enteroscopy or reoperation.Anatomical changes after RYGB increase the complexity of managing common bile duct stones.Among improved endoscopic retrograde cholangiopancreatography(ERCP)techniques,endoscopic ultrasound-guided transgastric ERCP has emerged as a minimally invasive and efficient option,though its long-term safety remains to be fully validated.For patients experiencing weight regain,endoscopic interventions include endoscopic sleeve gastroplasty and transoral outlet reduction(TORe),with TORe offering the dual benefits of narrowing the anastomosis and relieving dumping syndrome.The risk of gastroesophageal reflux disease increases after SG;balloon dilation can relieve reflux caused by anatomical stenosis,while emerging techniques such as anti-reflux mucosal resection and anti-reflux mucosal ablation are still under exploration.In refractory GERD cases,conversion to RYGB remains the mainstream solution.Overall,endoscopic techniques have significantly reduced reoperation rates through diverse strategies,but a balance must be maintained between procedural complexity and long-term efficacy.Future efforts should focus on device innovation,standardization of procedures,and multidisciplinary collaboration to improve the comprehensive management of complications following bariatric-metabolic surgery.
