Endoscopic examination of the operated stomach: a review and a systematic approach.

The endoscopist examining a patient with a history of gastric surgery is expected to know details of the history, the present physical condition, and relevant laboratory results. Familiarity with the appropriateness or limitations of different types of fiberscopes in relation to the individual case, and knowledge of how to overcome common difficulties, is important. The preparation must address the particular characteristics of the case, and the endoscopist must be aware of contraindications, complications, and recommendations to be observed in special circumstances. Based on situations confronted in daily practice, the authors suggest a systematic approach to the examination of patients with a history of gastric surgery, and point to the importance of observing the following steps: measurement of the length of the greater curvature in the gastric stump, verification of artifacts and anatomic modifications and their repercussions, removal of symptomatic suture line or staples, dilatation of strictures, fragmentation of bezoars, exeresis of polypoid lesions, collection of tissue samples, and regular follow up of the patients.