PTH-022 The endoscopic management of post-operative bariatric complications: single-centre, single-operator experience in a bariatric unit in the united kingdom

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Introduction The obesity epidemic has seen a corresponding rise in bariatric surgery, resulting in an increased prevalence of patients with post-operative complications from bariatric surgery. Endoscopists need to be aware of the symptoms and common findings seen at endoscopy, and the various endoscopic treatments available. Method A total 150 out of 1947 (7.7%) patients who underwent bariatric surgery for obesity were referred to the Endoscopy service between March 2011 and July 2014. We retrospectively reviewed the patient characteristics, type and interval following bariatric surgery, indications, findings and endoscopic intervention of these patients using our endoscopy database. Results 129 women (86%) and 21 men were referred to our service with a mean age of 47.2 years (range 22–74) following laparoscopic gastric bypass (59.7%), laparoscopic sleeve gastrectomy (28.4%) and laparoscopic band gastroplasty (11.9%). Presenting complaints 2–126 months post bariatric surgery included abdominal pain (49.3%), nausea and vomiting (20.6%), dysphagia (20.6%), profound weight loss and malabsorption (8.6%) and failure to lose weight (0.6%). Findings at endoscopy included anastomotic stenosis (23.8%), anastomotic ulceration (7.9%), visceral fistulation (4.6%), combined anastomotic ulceration with stenosis (3.3%) and band erosion (1.3%). A significant proportion of patients had macroscopically normal findings at endoscopy (58%). CLO tests for Helicobacter pylori were positive in 48% compared with 42% of unmatched historical controls within our department (p > 0.05). Endoscopic intervention either as a single procedure or on multiple occasions included 34 dilatations of anastomotic stricture by bougienage (22.5%), eighteen wire-guided balloon dilatations of anastomotic strictures (11.9%), eighteen naso-jejunal tube insertions for nutritional support (11.9%), six Ovesco clip applications (4.0%), and the repeated application of histoacryl glue to a visceral fistula in one case (0.7%). Conclusion The incidence of post-operative bariatric complications is not insignificant. These patients present with specific problems which are amenable to endoscopic therapy, and with which the endoscopy community will have to become more familiar as the prevalence of patients undergoing bariatric surgery continues to rise globally. Disclosure of interest None Declared.

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