Mark Loewen1, Carlos Barba. 1. St. Francis Hospital and Medical Center, Hartford, Connecticut, USA.
Abstract
BACKGROUND: Gastric bypass is an effective treatment for morbid obesity and can result in >60% excess weight loss initially. It has been reported that a 10-15% weight regain can occur in these patients. Few options are available to prevent this weight regain. The injection of morrhuate sodium as sclerotherapy has been suggested to decrease the diameter of the gastrojejunostomy anastamosis. METHODS: A total of 71 patients underwent sclerotherapy at their gastrojejunostomy from July 2004 to August 2006. A retrospective review was performed of this group, including chart review, follow-up data with weight checks, and telephone interview findings. RESULTS: The average age of the patients was 45 years, and all but 4 patients were women. Sclerotherapy was done an average of 2.9 years after gastric bypass. The starting weight at endoscopy was an average of 218 lb-18 lb heavier than the average nadir weight. The average diameter of the gastrojejunostomy was 2.3 cm. An average of 13 mL morrhuate sodium was injected circumferentially. Repeat therapy was performed in 35 patients (49%). No hospital admissions or complications occurred in relation to the procedure. During the 12-month follow-up period, 72% of patients maintained or lost weight. The analysis showed a high body mass index (at endoscopy) to be the only predictive factor for successful weight maintenance or loss. CONCLUSION: These results suggest that the use of endoscopic sclerotherapy could stabilize weight gain after gastric bypass. A randomized controlled study is necessary to validate these findings.
BACKGROUND: Gastric bypass is an effective treatment for morbid obesity and can result in >60% excess weight loss initially. It has been reported that a 10-15% weight regain can occur in these patients. Few options are available to prevent this weight regain. The injection of morrhuate sodium as sclerotherapy has been suggested to decrease the diameter of the gastrojejunostomy anastamosis. METHODS: A total of 71 patients underwent sclerotherapy at their gastrojejunostomy from July 2004 to August 2006. A retrospective review was performed of this group, including chart review, follow-up data with weight checks, and telephone interview findings. RESULTS: The average age of the patients was 45 years, and all but 4 patients were women. Sclerotherapy was done an average of 2.9 years after gastric bypass. The starting weight at endoscopy was an average of 218 lb-18 lb heavier than the average nadir weight. The average diameter of the gastrojejunostomy was 2.3 cm. An average of 13 mL morrhuate sodium was injected circumferentially. Repeat therapy was performed in 35 patients (49%). No hospital admissions or complications occurred in relation to the procedure. During the 12-month follow-up period, 72% of patients maintained or lost weight. The analysis showed a high body mass index (at endoscopy) to be the only predictive factor for successful weight maintenance or loss. CONCLUSION: These results suggest that the use of endoscopic sclerotherapy could stabilize weight gain after gastric bypass. A randomized controlled study is necessary to validate these findings.
Authors: Barham K Abu Dayyeh; Pichamol Jirapinyo; Zachary Weitzner; Charlotte Barker; Michael S Flicker; David B Lautz; Christopher C Thompson Journal: Gastrointest Endosc Date: 2012-08 Impact factor: 9.427