AGA publishes practice update on complications after bariatric, metabolic surgery
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The American Gastroenterological Association published a clinical practice update on the evaluation and management of early complications following bariatric and metabolic surgery.
“With the increasing adoption of bariatric/metabolic surgery, clinicians will more frequently encounter patients who suffer complications, despite advancements in surgical techniques,” Vivek Kumbhari, MD, PhD, Mayo Clinic, and colleagues wrote. “Clinicians performing endoscopic management, in addition to reviewing the operative report, should have detailed knowledge and experience with postsurgical anatomy. ... Having the ability to perform a wide array of therapies will enhance the likelihood that the optimal endoscopic strategy will be employed, as opposed to simply performing a technique with which the endoscopist has experience.”
Based on available published evidence, these updates address how clinicians should treat major postoperative complications, as well as the comprehensive knowledge needed to carry out various interventional endoscopic techniques.
Best practice advice statement highlights on the evaluation and management of complications follow.
If using an endoscopic approach, clinicians should approach treatment in a multidisciplinary manner with interventional radiology and bariatric/metabolic surgery co-managing the patient.
Clinicians should have a comprehensive knowledge of each endoscopic technique (indications, contradictions, risks, benefits, etc.), as well as knowledge of alternative methods such as surgical and interventional radiology-based approaches. Researchers further recommended expertise in interventional endoscopy techniques, including, but not limited to, concomitant fluoroscopy, stent deployment and retrieval, managing stenosis and managing percutaneous drains.
All patients must undergo screening for comorbid medical and psychological conditions, and endoscopic approach consideration in the immediate, early or late postoperative period is dependent on hemodynamic stability.
“Bariatric/metabolic surgery is unmatched with respect to its weight loss and metabolic benefits. The selection criteria will continue to broaden, likely resulting in increasing numbers of less robust patients undergoing surgery,” Kumbhari and colleagues concluded. “As utilization escalates, so will the number of patients who suffer early complications. Therefore, it is imperative that the endoscopist have the aptitude to efficiently evaluate and manage patients in a collaborative, multidisciplinary manner.”
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