Endoscopy in the bariatric patient
Obesity has become a healthcare problem of epidemic proportions. The etiology is complex and mostly sedentary life style and excessive caloric intake have been implicated. Numerous interventions have been used to treat the disease of obesity. Lifestyle modification along with a combination of healthy diet and exercise are usually first line strategies. This is often not durable in the majority of severely obese individuals. Pharmacotherapy is slightly more effective but recidivism is high once the medication is stopped. Surgical intervention has been shown to be safe, effective and durable. In the last several decades, endoscopic approaches to this disease have become increasingly popular. Endoscopy is an invaluable tool in the armamentarium of any bariatric surgeon or gastroenterologist taking care of bariatric patients. Pre procedural endoscopy remains controversial but is often performed. Post procedural endoscopy is important in identifying various anatomical changes created after these procedures. Endoscopy is increasingly being utilized to manage complications. This requires a thorough knowledge of such normal and altered anatomy in bariatric patients. In this manuscript, the use of endoscopy in the various aspects of the care of the bariatric patient will be reviewed.