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Endoscopy 2013; 45(07): 532-536
DOI: 10.1055/s-0032-1326638
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass

P. Jirapinyo
1   Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
2   Harvard Medical School, Boston, Massachusetts, USA
,
J. Slattery
1   Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
,
M. B. Ryan
1   Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
,
B. K. Abu Dayyeh
3   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
,
D. B. Lautz
2   Harvard Medical School, Boston, Massachusetts, USA
4   Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
,
C. C. Thompson
1   Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
2   Harvard Medical School, Boston, Massachusetts, USA
› Author Affiliations
Further Information

Publication History

submitted 04 September 2011

accepted after revision 22 February 2013

Publication Date:
25 June 2013 (online)

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Commentaire de travail de Jirapinyo P et al., pp. 532Endoscopy 2013; 45(07): 686-686
DOI: 10.1055/s-0033-1344603

Background and study aims: A dilated gastrojejunal anastomosis (GJA) is thought to be associated with weight regain in patients with Roux-en-Y gastric bypass (RYGB). Due to a high rate of perioperative morbidity, surgical revision is not generally performed. The aim of this study was to assess the technical feasibility, safety, and early outcomes of a procedure using a commercially available endoscopic suturing device to reduce the diameter of the GJA.

Patients and methods: This was a retrospective analysis of 25 consecutive patients who underwent transoral outlet reduction (TORe) for dilated GJA and weight regain. An endoscopic suturing device was used to place sutures at the margin of the GJA in order to reduce its aperture. On chart review, clinical data were available at 3, 6, and 12 months.

Results: Patients had regained a mean of 24 kg from their weight loss nadir and had a mean body mass index of 43 kg/m2 at the time of endoscopic revision. Average anastomosis diameter was 26.4 mm. Technical success was achieved in all patients (100 %) with a mean reduction in anastomosis diameter to 6 mm (range 3 – 10 mm), representing a 77.3 % reduction. The mean weight loss in successful cases was 11.5 kg, 11.7 kg, and 10.8 kg at 3, 6, and 12 months, respectively. There were no major complications.

Conclusion: This case series demonstrated the technical feasibility, safety, and efficacy of performing gastrojejunostomy reduction using a commercially available endoscopic suturing device. This technique may represent an effective and minimally invasive option for the management of weight regain in patients with RYGB.

 

  • References

  • 1 World Health Organization. Obesity and overweight. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/ Accessed 1 September 2011
    PubMedGoogle Scholar
  • 2 Sjostorm L, Narbro K, Sjostrom CD et al. Effects of bariatric surgery on mortality in Swedish obese subjects. New Engl J Med 2007; 357: 741-752
    CrossrefPubMedGoogle Scholar
  • 3 Santry HP, Gilen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005; 294: 1909-1917
    CrossrefPubMedGoogle Scholar
  • 4 Encinosa WE, Bernard DM, Steiner CA et al. Use and costs of bariatric surgery and prescription weight-loss medications. Health Aff (Millwood) 2005; 24: 1039-1046
    CrossrefPubMedGoogle Scholar
  • 5 Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow up. J Laparoendosc Adv Surg Tech 2011; 11: 377-382
    PubMedGoogle Scholar
  • 6 Whittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000; 10: 233-239
    CrossrefPubMedGoogle Scholar
  • 7 Buchwald H, Avidor Y, Braunwalkd E et al. Bariatric surgery: a systemic review and meta-analysis. JAMA 2004; 292: 1724-1737
    CrossrefPubMedGoogle Scholar
  • 8 Magro DO, Geloneze B, Delfini R et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg 2008; 18: 648-651
    CrossrefPubMedGoogle Scholar
  • 9 Surgerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg 1987; 205: 613-624
    CrossrefPubMedGoogle Scholar
  • 10 Powers PS, Rosemurgy A, Boyd F et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg 1997; 7: 471-477
    CrossrefPubMedGoogle Scholar
  • 11 Christou N, Look D, Maclean L. Weight gain after short- and long-limb gastric bypass in patients followed for more than 10 years. Ann Surg 2006; 244: 734-740
    CrossrefPubMedGoogle Scholar
  • 12 Sjostrom L, Lindroos A, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683-2693
    CrossrefPubMedGoogle Scholar
  • 13 Peruginin RA, Mason R, Czerniach DR et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003; 138: 541-545
    CrossrefPubMedGoogle Scholar
  • 14 Odom J, Zalesin KC, Washington TL et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg 2010; 20: 349-356
    CrossrefPubMedGoogle Scholar
  • 15 Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 2011; 9: 228-233
    CrossrefPubMedGoogle Scholar
  • 16 Gumbs AA, Pomp A, Gagner M. Revisional bariatric surgery for inadequate weight loss. Obes Surg 2007; 17: 1137-1145
    CrossrefPubMedGoogle Scholar
  • 17 Schwartz R, Strodel W, Simpson W et al. Gastric bypass revision: lessons learned from 920 cases. Surgery 1988; 104: 806-812
    PubMedGoogle Scholar
  • 18 Catalano MF, Rudic G, Anderson AJ et al. Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc 2007; 66: 240-245
    CrossrefPubMedGoogle Scholar
  • 19 Abu Dayyeh BK, Jirapinyo P, Weitzner Z et al. 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: 275-282
    CrossrefPubMedGoogle Scholar
  • 20 Thompson CC, Slattery J, Bundga ME et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc 2006; 20: 1744-1748
    CrossrefPubMedGoogle Scholar
  • 21 Mullady DK, Lautz DB, Thompson CC. 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: 440-444
    CrossrefPubMedGoogle Scholar
  • 22 Mikami D, Needleman B, Narula V et al. Natural orifice surgery: initial US experience utilizing the StomaphyX device to reduce gastric pouches after Roux-en-Y gastric bypass. Surg Endo 2010; 24: 223-228
    CrossrefPubMedGoogle Scholar
  • 23 Leitman IM, Virk CS, Avgerinos DV et al. Early results of trans-oral endoscopic plication and revision of the gastric pouch and stoma following Roux-en-Y gastric bypass surgery. JSLS 2010; 14: 217-220
    CrossrefPubMedGoogle Scholar
  • 24 Horgan S, Jacobsen G, Weiss GD et al. Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis 2010; 6: 290-295
    CrossrefPubMedGoogle Scholar
  • 25 Thompson CC, Jacobsen GR, Schroder GL et al. Stoma size critical to 12-month outcomes in endoscopic suturing for gastric bypass repair. Surg Obes Relat Dis 2012; 8: 282-287
    CrossrefPubMedGoogle Scholar
  • 26 Linner JH, Drew RL. Reoperative surgery – indications, efficacy, and long term follow-up. Am J Clin Nutr 1992; 55 : 606S-610S
    PubMedGoogle Scholar
  • 27 Hu B, Chung SC, Sun LC et al. Eagle Claw II: a novel endosuture device that uses a curved needle for major arterial bleeding: a bench study. Gastrointestinal Endoscopy 2005; 62: 266-270
    CrossrefPubMedGoogle Scholar