Cai Jennifer X, Schweitzer Michael A, Kumbhari Vivek
*Department of Medicine, Division of Gastroenterology and Hepatology †Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
Surg Laparosc Endosc Percutan Tech. 2016 Apr;26(2):93-101. doi: 10.1097/SLE.0000000000000230.
Obesity is a global epidemic that has significant impact on morbidity, mortality, and rising health care costs. In morbidly obese patients with body mass index >40 kg/m2, bariatric surgery is a grade A recommendation and is associated with up to 40% reduction in premature death. Increasingly, endoscopy is seen as a safer and more cost-effective approach to the management of weight loss surgery complications including gastrointestinal bleeding, development of anastomotic ulcers, staple-line leaks and fistulas, strictures, weight regain, bezoars, choledocholithiasis, and gastric band erosion and slippage. Many endoscopic interventions currently rely on a combination of specialized equipment, such as stents, suture systems, clips, and balloon dilators to successfully treat these issues. This article will present common postoperative complications in bariatric surgery, discuss the latest evidence for their endoscopic management, and offer future directions in the endoluminal therapy of obese patients.
肥胖是一种全球性流行病，对发病率、死亡率以及不断攀升的医疗成本产生重大影响。对于体重指数>40 kg/m2的病态肥胖患者，减肥手术是A级推荐，且与过早死亡风险降低高达40%相关。越来越多的人认为，在内镜检查是一种更安全、更具成本效益的方法，可用于处理减肥手术并发症，包括胃肠道出血、吻合口溃疡形成、吻合钉线漏和瘘、狭窄、体重反弹、胃石、胆总管结石以及胃束带侵蚀和移位。目前，许多内镜干预措施依赖于特殊设备的组合，如支架、缝合系统、夹子和球囊扩张器，以成功治疗这些问题。本文将介绍减肥手术常见的术后并发症，讨论其内镜治疗的最新证据，并提供肥胖患者腔内治疗的未来方向。
