1. Clinicians performing endoscopic approaches to treat early major postoperative complications should do so in a multidisciplinary manner with interventional radiology and bariatric or metabolic surgery co-managing the patient. Daily communication is advised.
2. Clinicians embarking on incorporating endoscopic management of bariatric or metabolic surgical complications into their clinical practice should have a comprehensive knowledge of the indications, contraindications, risks, benefits and outcomes of each of the endoscopic treatment techniques. They should also have knowledge of the risks and benefits of alternative methods such as surgical and interventional radiological based approaches.
3. Clinicians incorporating endoscopic management of bariatric or metabolic surgical complications into their clinical practice should have expertise in interventional endoscopy techniques, including but not limited to: using concomitant fluoroscopy, stent deployment and retrieval, managing stenosis and managing percutaneous drains.
4. Clinicians should screen all patients undergoing endoscopic management of bariatric or metabolic surgical complications and dietary intolerance for comorbid medical (nutrient deficiencies, infection, pulmonary embolism) and psychological (depression, anxiety) conditions.
5. Endoscopic approaches to managing complications of bariatric or metabolic surgery may be considered for patients in both the immediate, early and late postoperative periods depending on hemodynamic stability.
6. Clinicians incorporating endoscopic management of bariatric or metabolic surgical complications into their clinical practice should have a detailed understanding of the pathophysiologic mechanisms initiating and perpetuating conditions such as staple-line leaks. This will allow for a prompt diagnosis and appropriate therapy to be targeted not only at the area of interest, but also any concomitant downstream stenosis.
7. Clinicians should recognize that the goal for endoscopic management of staple-line leaks are often not necessarily initial closure of the leak site, but rather techniques to promote drainage of material from the perigastric collection into the gastric lumen such that the leak site closes by secondary intention.
