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The laparoscopic vertical sleeve gastrectomy (LVSG) has become the most popular operation for the treatment of morbid obesity in the United States. Being a purely restrictive procedure, the LVSG works to reduce the caloric intake of patients as well as decrease appetite through removal of ghrelin producing cells. Initially developed as the first part of a combined two step restrictive and malabsorptive procedure, the LVSG developed as a standalone procedure when patients lost significant weight with the restrictive portion of the operation alone. Short term outcomes have been promising in terms of weight loss and resolution of comorbid conditions. Long term outcomes are still evolving, but do demonstrate durable weight loss for a significant number of patients. Concerns with the LVSG in the long term revolve around development or worsening of gastroesophageal reflux disease or weight regain. The LVSG has been demonstrated to be a useful tool in the surgical management of morbid obesity.

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.