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Endoscopy 2019; 51(07): 684-688
DOI: 10.1055/a-0866-9427
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic full-thickness transoral outlet reduction with semicircumferential endoscopic submucosal dissection

Marcus Hollenbach
1   Medical Department II – Gastroenterology, Hepatology, Infectious Diseases, Pulmonology – University of Leipzig Medical Center, Leipzig, Germany
,
Lars Selig
1   Medical Department II – Gastroenterology, Hepatology, Infectious Diseases, Pulmonology – University of Leipzig Medical Center, Leipzig, Germany
,
Sylvia Lellwitz
2   IFB Adiposity Diseases, University of Leipzig Medical Center, Leipzig, Germany
,
Sebastian Beer
1   Medical Department II – Gastroenterology, Hepatology, Infectious Diseases, Pulmonology – University of Leipzig Medical Center, Leipzig, Germany
,
Jürgen Feisthammel
1   Medical Department II – Gastroenterology, Hepatology, Infectious Diseases, Pulmonology – University of Leipzig Medical Center, Leipzig, Germany
,
Jonas Rosendahl
3   Department of Medicine, Clinic for Internal Medicine I – Gastroenterology, Pneumonology, Gastrointestinal Oncology – Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
,
Tiffany Schaumburg
1   Medical Department II – Gastroenterology, Hepatology, Infectious Diseases, Pulmonology – University of Leipzig Medical Center, Leipzig, Germany
,
Joachim Mössner
1   Medical Department II – Gastroenterology, Hepatology, Infectious Diseases, Pulmonology – University of Leipzig Medical Center, Leipzig, Germany
,
Albrecht Hoffmeister
1   Medical Department II – Gastroenterology, Hepatology, Infectious Diseases, Pulmonology – University of Leipzig Medical Center, Leipzig, Germany
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Publikationsverlauf

submitted 06. September 2018

accepted after revision 04. Februar 2019

Publikationsdatum:
15. April 2019 (online)

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Einführung zu diesem Artikel:

Endoscopic full-thickness transoral outlet reduction with endoscopic submucosal dissection or argon plasma coagulation: does it make a difference?Endoscopy 2019; 51(07): 617-618
DOI: 10.1055/a-0894-4457

Abstract

Background Endoscopic full-thickness transoral outlet reduction (efTOR) is a therapeutic option to reduce a dilated gastrojejunal anastomosis (GJA) after Roux-en-Y gastric bypass (RYGB). Mucosal ablation with argon plasma coagulation (APC) is usually performed to achieve tissue adaptation. However, rupture of sutures before scarring can lead to recurrent dilatation of the GJA. Here, we describe efTOR with a semicircumferential endoscopic submucosal dissection (ESD-efTOR) as an alternative to APC-efTOR.

Methods We enrolled 41 patients with comparable baseline characteristics (APC-efTOR 26; ESD-efTOR 15). The main objectives were reduction in the GJA diameter and in ruptured sutures. Technical success, complications, total weight loss (TWL), and percentage of total and excess weight loss (%TWL and %EWL) at 3 and 12 months, were assessed.

Results ESD-efTOR resulted in significantly fewer ruptured sutures (20 % vs. 69 %; P = 0.004) and a greater reduction in the GJA (major 20 % vs. 0 %; minor 54 % vs. 37 %; no reduction 13 % vs. 58 %; P = 0.02) after 3 months. Technical efficacy, examination time, and rate of complications were comparable.

Conclusions ESD-efTOR resulted in a significantly greater reduction in the GJA diameter and a lower risk of ruptured sutures compared with APC-efTOR.

Table 1s

 

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