Obesity is an emerging global health problem, which threatens to negatively impact gains in longevity. In 1991, the National Institutes of Health consensus development panel recommended bariatric surgery for patients with grade 3 obesity (BMI ≥ 40 kg/m2) or with grade 2 (BMI 35–40 kg/m2) with coexisting comorbidities. The endoscopic treatment, mainly through the intragastric balloon placement, has been also an attractive procedure since it can be easily deployed and is reversible. Currently available balloons can usually induce short-term weight loss, but are not more effective than a diet and are ineffective for sustained weight loss. New endoscopic techniques are being developed aiming at minimally invasive treatments and as a primary intervention for obesity.1,2 The development of Endoscopic suturing devices and the concept of “NOTES—natural orifice transluminal Endoscopic surgery” are creating expectations regarding the possibility of endoscopically created restrictive gastroplasty and gastrojejunal anastomosis. Currently these procedures are being tested in animal models and it will take some time before confirmation of its efficacy.
Bariatric surgery has emerged as the treatment of choice for the patients with morbid obesity. The widespread use of bariatric surgery is justified by its safety and good results, associated with the impact that these procedures have through media.
Multidisciplinary teams composed of surgeons, clinicians, endocrinologists, psychologists, and nutritionists prepare patients for surgery in order to decrease the frequency of postoperative complications. Endoscopists should be a part of that team because endoscopic evaluation may be necessary to investigate and treat various surgical complications. With this in mind, the primary aim of this study is to review some endoscopic procedures during the pre and postoperative period of these patients.
The most commonly employed surgical options include Roux-en-Y gastric bypass (RYGBP) procedure with or without silicone ring (SR) and adjustable gastric banding (Lap-Band).
For most patients with RYGBP, a standard gastroscope can be used to evaluate the esophagus, gastric pouch, gastrojejunal anastomosis, and proximal portion of the Roux limb. A pediatric colonoscope or enteroscope may be required to examine the jejunojejunal anastomosis. More recently, the equipment named Double Balloon Enteroscope (Fujinon Corporation, Saitama, Japan) may be used to examine the biliopancreatic limb and the bypassed stomach.
The Endoscopy Unit should have appropriate bariatric hospital beds as well as the availability of facilities for general anesthesia. Morbid obesity is associated by marked respiratory comorbidities such as obstructive sleep apnea, restrictive lung disease, and occasionally pulmonary hypertension. During anesthesia, patients with morbid obesity may develop large alveolar-to-arterial oxygen gradients that may require higher inspiratory oxygen to maintain adequate oxygenization. The use of supplemental oxygen may improve this situation, but it must be emphasized that this may mask alveolar hypoventilation. In fact, the sampling rates of commonly used pulse oximeters may affect the detection of hypoxemia. The type and the sedation dose should be individualized. The careful association of fentanyl and midazolam gives an adequate short time ...