Endoscopic Gastrojejunal Revisions Following Gastric Bypass: Lessons Learned in More Than 100 Consecutive Patients

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2018 Sep 15

PMID 30215199

Citations 7

Authors

Catherine Tsai

Rudolf Steffen

Ulf Kessler

Hans Merki

Joerg Zehetner

Affiliations

Soon will be listed here.

Abstract

Background: Weight regain and dumping after Roux-en-Y gastric bypass (RYGB) are long-term challenges thought to be due to dilation of the gastrojejunal anastomosis. The aim of this study was to analyze the feasibility, safety, and outcomes of endoscopic gastrojejunal revisions (EGRs) after its introduction in a tertiary bariatric surgery center.

Methods: From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing EGR with the OverStitch suturing device. Demographics, procedure details, and outcomes were recorded.

Results: There were 107 patients (M:F = 29:78) treated with 133 EGR procedures for weight regain (n = 81), dumping syndrome (n = 13), or both (n = 13) with mean age 47.3 years (R 22.0-72.9) and mean BMI 32.9 kg/m (R 22.2-49.8) at time of procedure. Mean procedure time was 17.8 min (R 12-41), with median 1 suture used (R 1-2). No intra-operative or 30-day complications were recorded. Mean follow-up time was 9.2 months (R 1-26.8). Patients lost a mean of 4.1, 5.8, and 8.0 kg at 3, 6, and 12 months, respectively, after the procedure. Weight loss outcomes were significantly better when two compared to one suture was used (p = 0.036), and for patients with higher starting BMI (p = 0.047). For patients with dumping syndrome, 90-100% had treatment response after one or two EGRs.

Conclusion: EGR is feasible and safe for weight regain and dumping syndrome after RYGB. It can stabilize weight regain and improve dumping symptoms. Around 20% of patients will need repeat EGR within 1 year to achieve sufficient narrowing of the anastomosis.

Citing Articles

Long-term results after transoral outlet reduction (TORe) of the gastrojejunal anastomosis for secondary weight regain and dumping syndrome after Roux-en-Y gastric bypass.

Lovis J, Fischli S, Mongelli F, Muhlhausser J, Aepli P, Sykora M Surg Endosc. 2024; 38(8):4496-4504.

PMID: 38914888 PMC: 11289335. DOI: 10.1007/s00464-024-10989-3.

Society for Endocrinology guidelines for the diagnosis and management of post-bariatric hypoglycaemia.

Hazlehurst J, Khoo B, Lobato C, Ilesanmi I, Abbott S, Chan T Endocr Connect. 2024; 13(5).

PMID: 38451861 PMC: 11046333. DOI: 10.1530/EC-23-0285.

Transoral Outlet Reduction (TORe) for the Treatment of Weight Regain and Dumping Syndrome after Roux-en-Y Gastric Bypass.

Hakiza L, Sartoretto A, Burgmann K, Kumbhari V, Matter C, Seibold F Medicina (Kaunas). 2023; 59(1).

PMID: 36676749 PMC: 9865659. DOI: 10.3390/medicina59010125.

Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction.

Matteo M, Gallo C, Pontecorvi V, Bove V, De Siena M, Carlino G J Pers Med. 2022; 12(10).

PMID: 36294803 PMC: 9605651. DOI: 10.3390/jpm12101664.

Efficacy of transoral outlet reduction in Roux-en-Y gastric bypass patients to promote weight loss: a systematic review and meta-analysis.

Singh Dhindsa B, Saghir S, Naga Y, Dhaliwal A, Ramai D, Cross C Endosc Int Open. 2020; 8(10):E1332-E1340.

PMID: 33015335 PMC: 7511267. DOI: 10.1055/a-1214-5822.

References

Riva P, Perretta S, Swanstrom L . Weight regain following RYGB can be effectively treated using a combination of endoscopic suturing and sclerotherapy. Surg Endosc. 2016; 31(4):1891-1895. DOI: 10.1007/s00464-016-5189-y. View

Patel L, Lapin B, Brown C, Stringer T, Gitelis M, Linn J . Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction. Surg Endosc. 2016; 31(6):2667-2677. DOI: 10.1007/s00464-016-5281-3. View

Jirapinyo P, Slattery J, Ryan M, Abu Dayyeh B, Lautz D, Thompson C . Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Endoscopy. 2013; 45(7):532-6. DOI: 10.1055/s-0032-1326638. View

Borbely Y, Winkler C, Kroll D, Nett P . Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass. Obes Surg. 2016; 27(2):439-444. DOI: 10.1007/s11695-016-2329-3. View

Stier C, Chiappetta S . Endoluminal Revision (OverStitch (TM) , Apollo Endosurgery) of the Dilated Gastroenterostomy in Patients with Late Dumping Syndrome After Proximal Roux-en-Y Gastric Bypass. Obes Surg. 2016; 26(8):1978-84. DOI: 10.1007/s11695-016-2266-1. View

Vargas E, Bazerbachi F, Rizk M, Rustagi T, Acosta A, Wilson E . Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc. 2017; 32(1):252-259. PMC: 9707293. DOI: 10.1007/s00464-017-5671-1. View

Abu Dayyeh B, Jirapinyo P, Weitzner Z, Barker C, Flicker M, Lautz D . Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures. Gastrointest Endosc. 2012; 76(2):275-82. PMC: 4428559. DOI: 10.1016/j.gie.2012.03.1407. View

Thompson C, Chand B, Chen Y, DeMarco D, Miller L, Schweitzer M . Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology. 2013; 145(1):129-137.e3. DOI: 10.1053/j.gastro.2013.04.002. View

Adams K, Schatzkin A, Harris T, Kipnis V, Mouw T, Ballard-Barbash R . Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006; 355(8):763-78. DOI: 10.1056/NEJMoa055643. View

10.

Kumar N, Thompson C . The pursestring technique for endoscopic revision of gastric bypass. Gastrointest Endosc. 2015; 82(5):956. PMC: 4758215. DOI: 10.1016/j.gie.2015.05.052. View

11.

Fernandez-Esparrach G, Lautz D, Thompson C . Peroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis. 2009; 6(1):36-40. DOI: 10.1016/j.soard.2009.04.002. View

12.

Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R . Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009; 6(10):583-90. DOI: 10.1038/nrgastro.2009.148. View

13.

Carvajal S, Mulvihill S . Postgastrectomy syndromes: dumping and diarrhea. Gastroenterol Clin North Am. 1994; 23(2):261-79. View

14.

Loewen M, Barba C . Endoscopic sclerotherapy for dilated gastrojejunostomy of failed gastric bypass. Surg Obes Relat Dis. 2007; 4(4):539-42. DOI: 10.1016/j.soard.2007.09.014. View

15.

Abu Dayyeh B, Lautz D, Thompson C . Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2010; 9(3):228-33. PMC: 3043151. DOI: 10.1016/j.cgh.2010.11.004. View

16.

Cai J, Schweitzer M, Kumbhari V . Endoscopic Management of Bariatric Surgery Complications. Surg Laparosc Endosc Percutan Tech. 2016; 26(2):93-101. DOI: 10.1097/SLE.0000000000000230. View

17.

Giurgius M, Fearing N, Weir A, Micheas L, Ramaswamy A . Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Endosc. 2014; 28(5):1454-9. DOI: 10.1007/s00464-013-3376-7. View

18.

Mullady D, Lautz D, Thompson C . Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). Gastrointest Endosc. 2009; 70(3):440-4. DOI: 10.1016/j.gie.2009.01.042. View

19.

Pories W . Bariatric surgery: risks and rewards. J Clin Endocrinol Metab. 2008; 93(11 Suppl 1):S89-96. PMC: 2729256. DOI: 10.1210/jc.2008-1641. View

20.

Horgan S, Jacobsen G, Weiss G, Oldham Jr J, Denk P, Borao F . Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis. 2010; 6(3):290-5. DOI: 10.1016/j.soard.2009.12.011. View