Common postoperative anatomy that requires special endoscopic consideration

Technological advancements have continued to expand the utility of flexible endoscopy in the diagnosis and treatment of gastrointestinal disorders [1]. While the majority of these procedures occur in patients with native anatomy, the cohort of patients with surgically altered gastrointestinal anatomy continues to rise. Understanding the types of and variations of surgically-altered anatomy is paramount to effectively performing endoscopy in the postsurgical patient, as the anatomic rearrangements have implications to procedural safety and success. Additionally, the ability to distinguish “normal” from “abnormal” from “abnormally abnormal” postoperative findings is essential to correctly identify and report problems.

This article will describe common postsurgical anatomy that the endoscopist is likely to encounter. We describe normal and abnormal findings and detail technical considerations for obtaining accurate diagnostic information and performing therapeutic procedures vis-à-vis specific anatomical changes. Additionally, we highlight the essential components of specific endoscopic evaluations and outline methods to more effectively communicate such information to the referring provider (with particular focus on communicating anatomical findings with a surgeon).