dc.description.abstract | As management of upper gastrointestinal malignancies
improves, and with popularization of bariatric surgery, endoscopists are likely to meet patients with altered upper
gastrointestinal anatomy. Short-term, the surgery can cause
complications like bleeding, leaks, and fistulas, and longer-term
problems such as intestinal or biliary anastomotic strictures or
biliary stones can arise, all necessitating endoscopy. In addition,
the usual upper gastrointestinal pathologies can also still occur.
These patients pose unique challenges. To proceed, understanding the new layout of the upper gastrointestinal tract is
essential. The endoscopist, armed with a clear plan for
navigation, can readily diagnose and manage most commonly
occurring conditions, such as marginal ulcers and proximal
anastomotic strictures with standard endoscopic instruments.
With complex reconstructions involving long segments of small
bowel, such as Roux-en-Y gastric bypass, utilization of
balloon-assisted enteroscopy may be necessary, mandating
modification of procedures such as endoscopic retrograde
cholangiopancreatography. Successful endoscopic management of patients with altered anatomy will require prior
planning and preparation to ensure the appropriate equipment,
setting, and skill set is provided. | en_US |