Post-Op Endoscopic Sleeve Gastroplasty Concerns*

WARNING: Unpleasant symptoms occurring after a weight loss procedure can indicate a progressing and/or life-threatening problem that could require immediate hospitalization or surgery to control. Failure to notify the doctor immediately could result in preventable injury or death. Call 713-993-7124 IMMEDIATELY if untoward symptoms occur.

In general, the first few weeks after a procedure is an important period to monitor for problems, as the majority of complications will occur during this time. Bleeding and abdominal infection, which are the most serious problems, tend to occur just after surgery and are less likely later in this period

Bleeding

This is the most common complication during and after an ESG. Because the stomach has a rich blood supply, and the sutures are placed deep into the gastric wall, significant bleeding can be seen during the procedure. Usually this is well controlled by applying the synching device to tighten the suture. Rarely, an additional endoscopic technique (or even surgery) could be required to control bleeding.

It is possible that a patient could also later develop symptoms and signs of bleeding. Symptoms include, dizziness, appearing pale, shortness of breath, rapid heart-beat, low or absent urine output, vomiting blood or “coffee grounds”, or passing blood or black stools by rectum. Any of these symptoms should be communicated to the Endoscopist/Surgeon IMMEDIATELY.

Significant bleeding could require blood transfusion or extended hospital monitoring. Persistent or clinically significant bleeding could require repeat endoscopy and/or surgery to treat. The risk of significant bleeding requiring transfusion appears to be less than 1% with ESG1.

Stomach Leak

This is potentially a life-threatening complication.  Theoretically, a stomach leak after ESG is from bacteria tracking out along a full thickness suture, and causing an infection in the abdominal space. This has been described as a peri-gastric inflammation, as seen on CT scan. Because, the leak after ESG appears to be more limited than after surgery, this process can be termed a “micro-leak.”

Symptoms of stomach leak include: rapid heart rate, dizziness, shortness of breath, fever, worsening abdominal pain, left chest or shoulder pain, abdominal distention, the appearance of illness and a general feeling that something is very wrong. Unfortunately, many of the symptoms may be absent or could be from something else (e.g. bleeding). Diagnosis is dependent upon a variety of information sources, such as: clinical assessment, vital sign measurement, laboratory tests (white blood cell count) and radiologic studies (CT scan).

The risk of an infection outside of the stomach after ESG appears to be less than 1%1. Intervention is based on clinical factors, but, in general, the treatment for a micro-leak after ESG is less invasive than the treatment of a leak after a surgical sleeve operation1. However, unusual or extreme cases could require an operation to manage.

Blood Clots

This is a rare problem which occurs in less than 1% of patients. Obese patients are more prone to developing blood clots in the veins of the legs than are normal weight patients. The clot is dangerous because if it were to break off it might travel up the blood stream to the lung where is could suddenly decrease blood flow. This is known as a pulmonary embolism and can be fatal.

The treatment is PREVENTION of the formation of blood clots. Our patients are given a short-acting blood thinner before their procedure and sequential leg squeezing devices are fitted over the legs during the operation. Although, both of these are somewhat effective, neither is anywhere near as effective as the main treatment, which is getting out of bed and walking soon after the procedure is over. EARLY MOBILIZATION is the key to preventing blood clots. It is the most important thing the patient can do for him/herself around the time of the surgery.

Stenoses

A stenosis is a narrowed area somewhere along the tapered tube of stomach. Since the ESG is done under endoscopic observation it is unlikely that the stomach would be closed off by a suture. More conceivable is a case where the particular patient’s gastric squeezing function is mismatched to the degree of tapering that has been done. Since gastric function is not easily measured prior to the procedure, there would not be way to accurately predict who might be vulnerable to this problem.

If a patient suffered from persistent nausea and vomiting after ESG, a repeat endoscopy might be indicated. Presumably, suture could be cut out to release the restriction of the original ESG. Since this problem has not been described in the ESG medical literature it is unknown how commonly this happens (or if it does indeed occur at all).

Esophageal Injury

Performing an ESG requires placement of instruments and tubes through the esophagus to reach the stomach. These include, in order, a small caliber diagnostic endoscope, a large caliber over-tube, and a dual channel operating endoscope with the mounted suturing device. The esophagus is thinner walled than the stomach and more easily injured by instrumentation. Conversely, these instruments are placed under direct vision, or over a device already in position (over-tube). So, injury should be very uncommon.

A partial thickness injury to the esophagus can probably be managed conservatively. However, a full thickness injury might require surgery to repair and treat. Full thickness injury with ESG has not been reported in the medical literature.

IMPORTANT: The problems above are a partial list of all possible complications that can occur after this procedure. Some complications are rare and may be beyond the experience of the endoscopist or even the medical literature. Complications are usually not foreseeable.

WARNING: Unpleasant symptoms occurring after a weight loss procedure can indicate a progressing and/or life-threatening problem that could require immediate hospitalization or surgery to control. Failure to notify the doctor immediately could result in preventable injury or death. Call 713-993-7124 IMMEDIATELY if untoward symptoms occur.

* Results will vary by person and are based upon the patient, the surgery type and the compliance with the aftercare program. As with any medical procedure or surgery, there are specific risks and possible complications. The testimonials, statements, and opinions presented on our website are applicable to the individuals depicted. Results may not be representative of the experience of others. Testimonials are voluntarily provided and are not paid, nor were they provided with free products, services, or any benefits in exchange for said statements. The testimonials are representative of patient experience but the exact number of pounds lost and experience will be unique and individual to each patient.

1)     Lopez-Nava G, et al. Endoscopic Sleeve Gastroplasty for Obesity: a Multicenter Study of 248 Patients with 24 Months Follow-up. Obes Surg. April 27, 2017 (online).

* Results will vary by person and are based upon the patient, the surgery type and the compliance with the aftercare program. As with any medical procedure or surgery, there are specific risks and possible complications. The testimonials, statements, and opinions presented on our website are applicable to the individuals depicted. Results may not be representative of the experience of others. Testimonials are voluntarily provided and are not paid, nor were they provided with free products, services, or any benefits in exchange for said statements. The testimonials are representative of patient experience but the exact number of pounds lost and experience will be unique and individual to each patient.

Make an appointment with Dr. Marvin for diagnosis and treatment.