De Palma Giovanni D, Forestieri Pietro
Giovanni D De Palma, Center of Excellence for Technical Innovation in Surgery, Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, 80131 Naples, Italy.
World J Gastroenterol. 2014 Jun 28;20(24):7777-84. doi: 10.3748/wjg.v20.i24.7777.
Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett's esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases. Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery. There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings, such as large hiatal hernia or Barrett's esophagus, are detected preoperatively. The value of a routine endoscopy before bariatric surgery in asymptomatic patients (screening esophagogastroduodenoscopy) remains controversial. The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms, the management of complications, and the evaluation of weight loss failure. It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting. The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients.
在几乎所有西方国家，肥胖都是一个日益严重的健康问题。它是多种胃肠道疾病的重要危险因素，如胃食管反流病、糜烂性食管炎、食管裂孔疝、巴雷特食管、食管腺癌、幽门螺杆菌感染、结肠息肉和癌症、非酒精性脂肪性肝病、肝硬化以及肝细胞癌。手术是迄今为止最有效的治疗方法，可实现持续且显著的体重减轻，高达80%的病例中代谢合并症也会得到缓解。其中许多病症可能具有临床相关性，对接受减肥手术的患者有重大影响。有证据表明，如果术前检测到特定的上消化道病理结果，如大型食管裂孔疝或巴雷特食管，可能会改变所选的手术方式。减肥手术前对无症状患者进行常规内镜检查（筛查性食管胃十二指肠镜检查）的价值仍存在争议。减肥手术后患者内镜检查的常见适应证包括症状评估、并发症处理以及减肥失败评估。内镜医师熟悉术后解剖结构并与减肥手术同事密切合作至关重要，以便在此情况下最大限度地提高内镜检查的效果和安全性。本文旨在综述内镜医师在多学科肥胖中心中对减肥手术患者术前和术后管理所起的作用。
