ASGE Endo Hangout: Post-Surgical Anatomy in the Upper GI Tract / Bariatrics/Post-Bariatric Complications

Video Transcription

Video Summary

This ASGE EndoHangout webinar focused on endobariatrics for GI fellows through a case-based discussion led by expert endoscopists and a GI fellow moderator. The panel reviewed how to counsel patients with obesity on treatment options, emphasizing a “bucket” approach: lifestyle and behavioral therapy as the foundation, pharmacotherapy (especially GLP-1 agents), endoscopic interventions such as endoscopic sleeve gastroplasty (ESG), and bariatric surgery for more durable weight loss. They discussed BMI thresholds, insurance coverage, and the importance of tailoring recommendations to patient goals, comorbidities, expected weight loss, invasiveness, and durability.<br /><br />Several major post-bariatric complications were reviewed. For reflux after laparoscopic sleeve gastrectomy, the panel recommended upper endoscopy, given the increased risk of GERD and Barrett’s esophagus; ASGE guidance supports screening endoscopy about 3 years after sleeve and surveillance every 5 years if normal. They also reviewed management of sleeve leaks, emphasizing CT imaging, multidisciplinary care, and endoscopic drainage/closure strategies such as double pigtail stents, with ENDOVAC reserved mainly for refractory cases.<br /><br />For marginal ulcers after Roux-en-Y, the panel stressed open-capsule PPI therapy, smoking cessation, NSAID avoidance, and selective use of sucralfate. They also discussed weight regain after bypass and highlighted endoscopic revision options (TORe) using APC, suturing, or dissection. Finally, they reviewed biliary access after Roux-en-Y, favoring EDGE (EUS-directed transgastric ERCP) as the most effective approach.<br /><br />The session closed with personal reflections on training pathways, program-building challenges, and the growing role of endobariatrics in multidisciplinary obesity care.

Keywords

endobariatrics

obesity treatment

GI fellows

endoscopic sleeve gastroplasty

GLP-1 agents

bariatric surgery

GERD screening

sleeve gastrectomy complications

marginal ulcers

TORe

EDGE procedure

multidisciplinary obesity care