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The indications for quit smoking how to surgery are treatment of severe side effects like persistent nausea, vomiting, dumping syndrome or complications of previous bariatric surgery like stricture, non-healing ulcers, or inadequate weight loss.

Gastroenterologists play it s bad for your eyes to at a computer screen all day integral role in the pre- and post-operative management of patients undergoing bariatric surgery. It may also be important to detect abnormalities which may influence the choice of surgery or the development of post-operative symptoms and complications. Other, clinically, significant pathologies for consideration prior to surgery include reflux esophagitis, gastric ulcers, Helicobacter pylori infection, etc.

To quote a few examples, H. With an ever increasing number of surgeries Diltiazem Hydrochloride Extended Release Capsules (Cartia XT)- FDA performed, the absolute number of complications is also increasing.

The immediate post-operative complications, like anastomotic leak, bleeding, small bowel obstruction, etc. The most common location for leaks Mirtazapine (Remeron)- Multum the staple line, no matter which type of bariatric surgery was performed.

These stents can be left in place for a prolonged time and patients may resume oral feeding after 1-3 days. Stent migration is a complication and the leak might recur. Fully covered stents can be removed endoscopically 7. Also post-operative bleeding, most often at the site of the anastomosis, and more likely in patients with underlying diabetes mellitus might be amenable to endoscopic therapy.

The use of hemostatic clips is preferred over the use of diathermy 5,7. However, common symptoms prompting endoscopy six weeks or more after bariatric surgery include upper abdominal pain, nausea, vomiting, dysphagia, and diarrhea. The etiology of these symptoms are multifactorial and include marginal ulcers, chronic anastomotic leaks, fistulae, strictures, band stenosis, erosion or slippage, staple line dehiscence, bezoars, choledocholithiasis, etc.

The endoscopic treatment of some of these conditions include balloon dilation of strictures, endoscopic removal of eroded bands, stenting of anastomotic leaks, endoscopic treatment of fistulae, and removal of bezoars and gall stones 2,4. There may be also be a role for preoperative gastrointestinal motility studies in some patients to select the appropriate type of surgery. LAGB is notorious for postoperative worsening of gastro-esophageal reflux (GERD) and can cause pseudo-achalasia due to an increase of the lower gastro-esophageal pressure and aperistalsis.

Similarly, VSG has been shown to aggravate GERD and can cause de novo It s bad for your eyes to at a computer screen all day. In contrast, RNYGBP has been demonstrated to improve GERD-like symptoms and maintains motility of the esophagus 8. Small intestinal bacterial overgrowth can occur after RNYGBP and can result in a variety of symptoms. Early and late dumping syndromes are well reported late complications. There is evidence for routine screening for essential fatty acids and vitamin E or K deficiency.

The etiology is multifactorial, including reduced intake, altered dietary choices, and malabsorption due to altered anatomy.

The nature and severity of deficiencies is dependent on the type of surgery, dietary habits, and the presence of other surgery related complications like nausea, vomiting, or diarrhea. The frequency of nutritional follow-up depends largely on the surgical procedure performed. Following LAGB, frequent nutritional follow-up is recommended. Guidelines were reviewed and published in 2013 on the perioperative nutritional, metabolic, and non-surgical support of these it s bad for your eyes to at a computer screen all day 3.

Routine post-operative nutritional monitoring and micronutrient supplementation is recommended in all bariatric patients particularly after malabsorptive procedures. Here, treatment with oral calcium and vitamin D is indicated to prevent secondary hyperparathyroidism.

Hypophosphatemia is often associated with vitamin D deficiency. In individual cases, the monitoring of bone density is recommended. Hyperinsulinemic hypoglycemia is a rare complication after procedures like RNYGBP which is attributed to nesidioblastosis and needs to be differentiated from dumping syndrome 9.

All patients should receive a multivitamin and mineral preparation 3. The endoscopist may have a very important role in the future with less invasive endoscopic procedures as alternatives for bariatric surgery, based on the journal organometallics principles.

Endoscopic introduction of various types of restrictive gastric balloons, bypass procedures with placement of duodenojejunal bypass sleeve or bypass liner, implantable devices to delay transit time of nutrients through the duodenum, gastric stapling, endoluminal vertical gastroplasty, endoluminal gastric plication, transoral endoscopic restrictive implant system, etc.

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