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Les e-mémoires de l'Académie Nationale de Chirurgie

l'endoscopie flexible dans le traitement de l'obésité morbide: du traitement des complications chirurgicales à des procédures "de novo"Endoscopic Bariatric Intrventions




AbstractEndoscopy is playing a growing role in the management of obesity.Transoral gastroplasty has been shown feasible and safe. It was demonstrated possible to create a vertical pouch with a distal endoluminal restriction. A 300 patients multicentric randomized sham controlled trial showed a significant advantage over the sham procedure but was judged insufficient by the FDA. Duodenojejunal sleeves induce a modest weight loss but are associated with significant improvement of diabetes. They are still a temporary treatment, given the fact that they can be left in place for only 6 months. Other implantable devices mimicking restrictive surgery are also under evaluation.Endoscopy is also playing a major role in the management of complications associated with bariatric surgical procedures. Anastomotic leaks are probably the most difficult complications occurring after RYGBP and sleeve gastrectomies. The use of sealants and sclerosing agents has been described in small series, as well as in attempts to close staple line dehiscence. Endoscopic stiching has also been reported in small series. The largest experience has been reported in treating post-bariatric surgery gastrocutaneous leaks using self-expandable metal stent. An elegant technique of successive placement of metal stents for closure of the fistula followed by the placement, after 2 to 4 months, of a plastic stent which induces by pressure a necrosis of the hyperplasia and allows the removal of the metal stent allows to manage a majority of cases. Endotherapy is also effective in the management of migrated bands and rings.