Ahrens Markus, Stier Christine
Chirurgische Klinik, AMEOS Klinikum Oldenburg, Mühlendamm 5, 23758, Oldenburg, Deutschland.
Chirurgie (Heidelb). 2023 Jun;94(6):518-524. doi: 10.1007/s00104-023-01836-7. Epub 2023 Mar 17.
Endoscopy has become established as an important component in all preoperative, intraoperative and postoperative areas of bariatric surgery. As guidelines are not yet available, relevant studies and international position papers have been collected in this article. Preoperatively, endoscopy should be performed before sleeve gastrectomy (SG, detection of reflux status) and before bypass procedures (status survey of the postoperatively no longer accessible distal stomach). Routine endoscopic monitoring should be performed 2-3 years after SG and a OAGB (one anastomosis gastric bypass) for recording of the gastroesophageal reflex disease (GERD) status. In the first line complication management of hemorrhage and leakages, endoscopic procedures have prevailed over surgical ones due to more causal therapeutic approaches (except cases of general peritonitis where lavage and drainages are needed). In the treatment of late complications such as dumping, anastomosis dilatation and stenosis, bariatric endoscopy provides versatile, organ-preserving solutions and continues to demonstrate a high degree of innovation. In these postoperative fields of application, especially in the treatment of late complications, specific knowledge of bariatric anatomy and physiology as well as surgical treatment options are required in addition to endoscopic expertise. The special field of bariatric endoscopy has developed and will have an own importance closely linked to the bariatric surgery.
内镜检查已成为减重手术术前、术中和术后所有领域的重要组成部分。由于目前尚无相关指南，本文收集了相关研究和国际立场文件。术前，应在袖状胃切除术（SG，检测反流状况）之前以及旁路手术之前（对术后无法再触及的远端胃进行状况检查）进行内镜检查。SG和单吻合口胃旁路术（OAGB）术后2 - 3年应进行常规内镜监测，以记录胃食管反流病（GERD）状况。在出血和渗漏的一线并发症处理中，由于内镜治疗方法更具针对性（一般腹膜炎需要冲洗和引流的情况除外），内镜手术已超过外科手术。在治疗倾倒、吻合口扩张和狭窄等晚期并发症时，减重内镜提供了多种保留器官的解决方案，并持续展现出高度的创新性。在这些术后应用领域，尤其是在治疗晚期并发症时，除了内镜专业知识外，还需要掌握减重解剖学和生理学以及手术治疗选择的具体知识。减重内镜这一特殊领域已经发展起来，并将与减重手术紧密相连，具有自身的重要性。
