BACKGROUND: Approximately 20-30 % of morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGB) will experience significant weight regain in the years following surgery. Endoscopic gastrojejunal revision (EGJR) has been shown to be a safe, effective and less invasive alternative to revisional surgery, with promising weight loss outcomes. However, minimal data exist regarding how to perform the procedure most effectively and what factors may predict good outcomes. We compared weight loss outcomes between patients undergoing endoscopic stoma revision by one of two full-thickness suturing techniques. METHODS: A retrospective review of patients undergoing EGJR between 06/2012 and 09/2015 was performed. Included patients were adults 18-74 years of age who had experienced weight regain ≥2 years after initial RYGB with stoma dilation ≥15 mm in diameter. Revision was done with either an interrupted (IRT) or purse-string (PST) suture technique. A linear mixed effects model was constructed to predict postoperative weight loss. RESULTS: Fifty revisions (IRT = 36, PST = 14) were performed in 47 patients (92 % female, mean age of 50.9 ± 10.9 years and body mass index of 41.4 ± 7.1 kg/m2). Technical success (stoma diameter ≤10 mm) was achieved in all cases. Final diameter was significantly smaller in the PST group, 6.6 ± 2.2 mm versus 4.8 ± 1.8 mm (p < 0.01), resulting in a significantly greater % stoma reduction (76.8 ± 8.5 % vs. 84.2 ± 5.1 %, p < 0.01) versus the IRT group. PST resulted in greater % excess weight loss over time compared to IRT. Sixteen comorbid conditions resolved among 12 patients. No major complications occurred. CONCLUSION: Endoscopic revision of the gastric outlet results in meaningful weight loss and comorbidity resolution in select patients experiencing weight regain following RYGB. A PST revision likely results in higher and more sustainable weight loss when compared to IRT.
BACKGROUND: Approximately 20-30 % of morbidly obesepatients undergoing Roux-en-Y gastric bypass (RYGB) will experience significant weight regain in the years following surgery. Endoscopic gastrojejunal revision (EGJR) has been shown to be a safe, effective and less invasive alternative to revisional surgery, with promising weight loss outcomes. However, minimal data exist regarding how to perform the procedure most effectively and what factors may predict good outcomes. We compared weight loss outcomes between patients undergoing endoscopic stoma revision by one of two full-thickness suturing techniques. METHODS: A retrospective review of patients undergoing EGJR between 06/2012 and 09/2015 was performed. Included patients were adults 18-74 years of age who had experienced weight regain ≥2 years after initial RYGB with stoma dilation ≥15 mm in diameter. Revision was done with either an interrupted (IRT) or purse-string (PST) suture technique. A linear mixed effects model was constructed to predict postoperative weight loss. RESULTS: Fifty revisions (IRT = 36, PST = 14) were performed in 47 patients (92 % female, mean age of 50.9 ± 10.9 years and body mass index of 41.4 ± 7.1 kg/m2). Technical success (stoma diameter ≤10 mm) was achieved in all cases. Final diameter was significantly smaller in the PST group, 6.6 ± 2.2 mm versus 4.8 ± 1.8 mm (p < 0.01), resulting in a significantly greater % stoma reduction (76.8 ± 8.5 % vs. 84.2 ± 5.1 %, p < 0.01) versus the IRT group. PST resulted in greater % excess weight loss over time compared to IRT. Sixteen comorbid conditions resolved among 12 patients. No major complications occurred. CONCLUSION: Endoscopic revision of the gastric outlet results in meaningful weight loss and comorbidity resolution in select patients experiencing weight regain following RYGB. A PST revision likely results in higher and more sustainable weight loss when compared to IRT.
Authors: Lars Sjöström; Anna-Karin Lindroos; Markku Peltonen; Jarl Torgerson; Claude Bouchard; Björn Carlsson; Sven Dahlgren; Bo Larsson; Kristina Narbro; Carl David Sjöström; Marianne Sullivan; Hans Wedel Journal: N Engl J Med Date: 2004-12-23 Impact factor: 91.245
Authors: Lea Fayad; Michael Schweitzer; Micheal Raad; Cem Simsek; Roberto Oleas; Margo K Dunlap; Tazkia Shah; Jay Doshi; Margueritta El Asmar; Andreas Oberbach; Vikesh K Singh; Kimberly Steele; Thomas Magnussen; Anthony N Kalloo; Mouen A Khashab; Vivek Kumbhari Journal: Obes Surg Date: 2019-07 Impact factor: 4.129
Authors: Rena C Moon; Andre F Teixeira; Manoel Galvao Neto; Natan Zundel; Bruno Queiroz Sander; Flavio Mitidieri Ramos; Felipe Matz; Giorgio A Baretta; Luiz Gustavo de Quadros; Eduardo Grecco; Thiago Souza; Sergio A Barrichello; Admar Concon Filho; Eduardo Nobuyuki Usuy; Artagnan Menezes Barbosa de Amorim; Muhammad A Jawad Journal: Obes Surg Date: 2018-09 Impact factor: 4.129
Authors: H Mason Hedberg; Alexander Trenk; Kristine Kuchta; John G Linn; JoAnn Carbray; Michael B Ujiki Journal: Surg Endosc Date: 2018-01-24 Impact factor: 4.584
Authors: Zachary M Callahan; Bailey Su; Kristine Kuchta; Eliza Conaty; Stephanie Novak; John Linn; Faris M Murad; JoAnn Carbray; Michael Ujiki Journal: J Gastrointest Surg Date: 2019-12-10 Impact factor: 3.452
Authors: R Vilallonga; J L Pereira-Cunill; S Morales-Conde; I Alarcón; I Breton; E Domínguez-Adame; J V Ferrer; A Garcia Ruiz-de-Gordejuela; A Goday; A Lecube; E Martín García-Almenta; M Á Rubio; F J Tinahones; P P García-Luna Journal: Obes Surg Date: 2019-12 Impact factor: 4.129
Authors: Eric J Vargas; Fateh Bazerbachi; Monika Rizk; Tarun Rustagi; Andres Acosta; Erik B Wilson; Todd Wilson; Manoel Galvao Neto; Natan Zundel; Manpreet S Mundi; Maria L Collazo-Clavell; Shah Meera; H S Abu-Lebdeh; Paul A Lorentz; Karen B Grothe; Matthew M Clark; Todd A Kellogg; Travis J McKenzie; Michael L Kendrick; Mark D Topazian; Christopher J Gostout; Barham K Abu Dayyeh Journal: Surg Endosc Date: 2017-06-29 Impact factor: 4.584