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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

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Abstract

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.

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Authors and Affiliations

  1. Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA

    Lava Y. Patel, Brittany Lapin, Craig S. Brown, Thomas Stringer, Matthew E. Gitelis, John G. Linn, Woody E. Denham, Elizabeth Farwell, Stephen Haggerty & Michael B. Ujiki

Authors
  1. Lava Y. Patel
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  2. Brittany Lapin
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  3. Craig S. Brown
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  4. Thomas Stringer
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  5. Matthew E. Gitelis
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  7. Woody E. Denham
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  8. Elizabeth Farwell
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  10. Michael B. Ujiki
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Correspondence to Michael B. Ujiki.

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Disclosures

Drs. Lava Patel, Brittany Lapin, Craig S Brown, Tom Stringer, Matthew Gitelis, John Linn, Woody Denham, Liz Farwell, Stephen Haggerty, Michael Ujiki have no conflicts of interest or financial ties to disclose. Dr. Ujiki is a consultant for Apollo Endosurgery.

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Patel, L.Y., Lapin, B., Brown, C.S. et al. 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 31, 2667–2677 (2017). https://doi.org/10.1007/s00464-016-5281-3

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