JB Most endoscopists who are asked this question would immediately think of anatomic problems that limit or prevent access to the main duodenal papilla for cannulation, such as prior upper gastrointestinal surgery (eg, Billroth II gastrectomy, Roux-en-Y biliary diversion, or gastric bypass procedures) or gastric outlet obstruction (Figure 1). However, the difficulty of an endoscopic retrograde ...

Access to the bypassed portion of the stomach after Roux-en-Y gastric bypass remains a challenge. We present a case of 64-year-old woman who presented with gastric outlet obstruction. We used a novel endoscopic technique to access the bypassed stomach by creating a jejunogastrostomy using a specialized stent, which allowed the insertion of a pediatric gastroscope to examine the bypassed portion...

BACKGROUND Circular-stapled anastomosis with trans-oral anvil insertion is one of the most commonly used methods for the creation of the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (LRYGB). We present a retrospective analysis of laparoscopic gastric bypass by comparing 2 techniques of circular-stapled gastrojejunostomy; Orvil(TM) and hand-made Orvil. METHODS Patients who were s...

BACKGROUND AND OBJECTIVES We hypothesized that patients who have previously had bariatric surgery and are undergoing revision to laparoscopic Roux-en-Y gastric bypass would have abnormal findings detected by upper endoscopy that could potentially influence patient management. The procedures that are being revised include vertical banded gastroplasty, laparoscopic adjustable gastric bands, nonad...

OBJECTIVES A precipitating factor for marginal ulcer formation after Roux-en-Y gastric bypass may be the prolonged irritation by foreign material, such as nonabsorbable suture at the gastrojejunostomy. This study examines the incidence of marginal ulcers before and after a change was made from using nonabsorbable suture to using absorbable suture for the inner layer of the anastomosis. METHOD...

BACKGROUND Fibrin sealants (FSs) have been used in both open and laparoscopic bariatric surgery to decrease the anastomotic leak rate; however, conclusive evidence to recommend routine use is still lacking. We studied FS use and its effect on the clinical inflammatory response after laparoscopic Roux-en-Y gastric bypass. METHODS Of 474 consecutive patients scheduled to undergo laparoscopic Ro...

Laparoscopic adjustable gastric banding (LAGB) is considered to be a safe and effective method of weight loss and reduction of comorbidities associated with obesity. Despite its improved early safety profile compared with Roux-en-Y gastric bypass, patients with LAGB can manifest unique complications that must be recognized and managed appropriately to achieve good outcomes. This review will pre...

BACKGROUND Bariatric surgery is the most effective treatment for obesity classes II and III. However, some patients do not get the desired results or initially lose and then regain the lost weight. Identifying these individuals early on and treating them adequately remains a challenge. As binge eating directly affects food intake, the study of this symptom and its relation to bariatric surgery ...

BACKGROUND The literature reports that gastrojejunal derivation with Roux-en-Y gastric bypass is highly efficient in controlling weight and resolving; but studies have shown worsened glycemic control in a considerable number of patients and associated factors that have not been fully elucidated. AIM To analyze the profile of patients submitted to gastric bypass that did not achieve satisfacto...

BACKGROUND Severe obesity remains the leading public health crisis of the industrialized world, with bariatric surgery the only effective and enduring treatment. Poor psychological adjustment has been occasionally reported postoperatively. In addition, evidence suggests that patients can metabolize alcohol differently after gastric bypass. STUDY DESIGN Preoperatively and at 3 and 6 months pos...