Skip to main content
SpringerLink
Log in

Endoscopic Therapy for Weight Regain After Bariatric Surgery

  • Chapter
  • First Online:
Bariatric Endoscopy

Abstract

With the cumulative increase in the number of patients undergoing bariatric surgery, postoperative weight regain has become a considerable challenge. Mechanisms for weight regain are not fully understood and the process is likely multifactorial in many cases. Less invasive endoluminal revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may have a more favorable risk profile compared to traditional surgical approaches in this population. Given the proliferation of endoluminal therapies with early evidence suggesting safety and efficacy in the treatment of weight regain, it is likely that endoscopic revision will be an increasingly prominent element in bariatric care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778–85.

    PubMed  Google Scholar 

  2. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults–the evidence report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S–209S.

    Google Scholar 

  3. North American Association for the Study of Obesity and the National Heart, Lung, and Blood Institute. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. NIH publication 00-4084; 2000.

    Google Scholar 

  4. Silecchia G, Perrotta N, Boru C, et al. Role of a minimally invasive approach in the management of laparoscopic adjustable gastric banding postoperative complications. Arch Surg. 2004;139:1225–30.

    Article  PubMed  Google Scholar 

  5. Klein S. Medical management of obesity: present and future therapy. J Gastrointest Surg. 2003;7(4):464–7.

    Article  PubMed  Google Scholar 

  6. Hauser DL, Titchner RL, Wilson MA, et al. Long-term outcomes of laparoscopic Roux-en-Y gastric bypass in US veterans. Obes Surg. 2010;20:283–9.

    Article  PubMed  Google Scholar 

  7. Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17:796–802.

    Article  Google Scholar 

  8. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  9. Mathus-Vliegen EM. The role of endoscopy in bariatric surgery. Best Pract Res Clin Gastroenterol. 2008;22:839–64.

    Article  PubMed  CAS  Google Scholar 

  10. Pratt GM, Learn CA, Hughes GD, et al. Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence. Surg Endosc. 2009;23:795–9.

    Article  PubMed  Google Scholar 

  11. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;13:1724–37.

    Article  Google Scholar 

  12. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.

    Article  PubMed  Google Scholar 

  13. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–85.

    PubMed  Google Scholar 

  14. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    PubMed  Google Scholar 

  15. Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243:181–8.

    Article  PubMed  Google Scholar 

  16. Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132:2253–71.

    Article  PubMed  Google Scholar 

  17. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  18. Mitchell JE, Lancaster KL, Burgard MA, et al. ­Long-term follow-up of patients’ status after gastric bypass. Obes Surg. 2001;11:464–8.

    Article  PubMed  CAS  Google Scholar 

  19. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.

    Article  PubMed  CAS  Google Scholar 

  20. Brolin RE. Bariatric surgery and long-term control of morbid obesity. JAMA. 2002;288:2793–6.

    Article  PubMed  Google Scholar 

  21. McCormick JT, Papasavas PK, Caushaj PF, Gagne DJ. Laparoscopic revision of failed open bariatric procedures. Surg Endosc. 2003;17:413–5.

    Article  PubMed  CAS  Google Scholar 

  22. Hsu LK, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric ­surgery: a review. Psychosom Med. 1998;60:338–46.

    PubMed  CAS  Google Scholar 

  23. Powers PS, Rosemurgy A, Boyd F, et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg. 1997;7:471–7.

    Article  PubMed  CAS  Google Scholar 

  24. Magro DO, Gelonese B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.

    Article  PubMed  Google Scholar 

  25. Christou NV, Look D, MacLean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734–40.

    Article  PubMed  Google Scholar 

  26. Prachand V, DaVee R, Alverdy J. Duodenal switch provides superior weight loss in the super-obese (BMI > 50 kg/m2) compared with gastric bypass. Ann Surg. 2006;244:611–9.

    PubMed  Google Scholar 

  27. Hsu LK, Betancourt S, Sullivan SP. Eating disturbances before and after vertical banded gastroplasty: a pilot study. Int J Eat Disord. 1996;19(1):23–34.

    Article  PubMed  CAS  Google Scholar 

  28. Spitzer RR, Devleu M, Waish BT, et al. Binge eating disorder: a multisite field trial of the diagnostic criteria. Int J Eat Disord. 1992;11:191–203.

    Article  Google Scholar 

  29. Malone M, Alger-Mayer S. Binge status and quality of life after gastric bypass surgery: a one-year study. Obes Res. 2004;12:473–81.

    Article  PubMed  Google Scholar 

  30. Flier JS. Clinical review 94: what’s in a name? In search of leptin’s physiologic role. J Clin Endocrinol Metab. 1998;83:1407–13.

    Article  PubMed  CAS  Google Scholar 

  31. Ahima RS, Prabakaran D, Mantzoros C, et al. Role of leptin in the neuroendocrine response to fasting. Nature. 1996;382:250–2.

    Article  PubMed  CAS  Google Scholar 

  32. Gumbs AA, Pomp A, Gagner M. Revisional bariatric surgery for inadequate weight loss. Obes Surg. 2007;17:1137–45.

    Article  PubMed  Google Scholar 

  33. Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2011;9(3):228–33.

    Article  PubMed  Google Scholar 

  34. Muller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15:1089–95.

    Article  PubMed  Google Scholar 

  35. Gagner M, Gentileschi P, de Csepel J, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12:254–60.

    Article  PubMed  Google Scholar 

  36. Behrns K, Smith C, Kelly K, et al. Reoperative ­bariatric surgery—lessons learned to improve patient selection and results. Ann Surg. 1993;218:646–53.

    Article  PubMed  CAS  Google Scholar 

  37. Cohen R, Pinheiro JS, Correa JL, Schiavon C. Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc. 2005;19:822–5.

    Article  PubMed  CAS  Google Scholar 

  38. Coakley BA, Deveney CW, Spight DH, et al. Revisional bariatric surgery for failed restrictive procedures. Surg Obes Relat Dis. 2008;4:581–6.

    Article  PubMed  Google Scholar 

  39. Linner JH, Drew RL. Reoperative surgery: indications, efficacy, and long term-follow-up. Am J Clin Nutr. 1992;55:606S–10.

    PubMed  CAS  Google Scholar 

  40. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–32.

    Article  PubMed  Google Scholar 

  41. Livingston EH. Hospital costs associated with bariatric procedures in the United States. Am J Surg. 2005;190(5):816–20.

    Article  PubMed  Google Scholar 

  42. Inabnet 3rd WB, Belle SH, Bessler M, et al. Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis. 2010;6:22–30.

    Article  PubMed  Google Scholar 

  43. Dapri G, Cadiere GB, Himpens J. Laparoscopic conversion of adjustable gastric banding and vertical banded gastroplasty to duodenal switch. Surg Obes Relat Dis. 2009;5:678–83.

    Article  PubMed  Google Scholar 

  44. Ryou M, Ryan MB, Thompson CC. Current status of endoluminal bariatric procedures for primary and revision indications. Gastrointest Endosc Clin N Am. 2011;21(2):315–33.

    Article  PubMed  Google Scholar 

  45. Woods EK, Abu Dayyeh BK, Thompson CC. Endoscopic post-bypass revisions. Tech Gastrointest Endosc. 2010;12:160–6.

    Article  Google Scholar 

  46. Spaulding L, Osler T, Patlak J. Long-term results of sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Obes Relat Dis. 2007;3:623–6.

    Article  PubMed  Google Scholar 

  47. 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;66:240–5.

    Article  PubMed  Google Scholar 

  48. Loewen M, Barba C. Endoscopic sclerotherapy for dilated gastrojejunostomy of failed gastric bypass. Surg Obes Relat Dis. 2008;4:539–42.

    Article  PubMed  Google Scholar 

  49. Thompson CT, 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;20:1744–8.

    Article  PubMed  CAS  Google Scholar 

  50. Thompson CC, Roslin MS, Bipan C, Chen YK, DeMarco DC, Miller LS et al. RESTORe: Randomized Evaluation of Endoscopic Suturing Transorally For Anastomotic Outlet Reduction: A Double-Blind, Sham-Controlled Multicenter Study for Treatment of Inadequate Weight Loss or Weight Regain Following Roux-en-Y Gastric Bypass. Gastroenterology. 2010;138(5 Suppl 1):S-388.

    Google Scholar 

  51. 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;70:440–4.

    Article  PubMed  Google Scholar 

  52. Seaman DL, Gostout CJ, de la Mora Levy JG, Knipschield MA. Tissue anchors for transmural gut-wall apposition. Gastrointest Endosc. 2006;64:577–81.

    Article  PubMed  Google Scholar 

  53. Ryou MK, Mullady DK, Lautz DB, Thompson CC. Pilot study evaluating technical feasibility and early outcomes of second-generation endosurgical platform for treatment of weight regain after gastric bypass surgery. Surg Obes Relat Dis. 2009;5(4):450–4.

    Article  PubMed  Google Scholar 

  54. Horgan S, Jacobsen G, Weiss GD, Oldham Jr JS, Denk PM, Borao F, et al. Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis. 2010;6:290–5.

    Article  PubMed  Google Scholar 

  55. 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 Endosc. 2010;24:223–8.

    Article  PubMed  Google Scholar 

  56. Letiman IM, Virk CS, Avgerinos DV, Patel R, Lavarias V, Surick B, et al. Early results of trans-oral endoscopic placation and revision of the gastric pouch and stoma following Roux-en-Y gastric bypass surgery. JSLS. 2010;14:217–20.

    Article  Google Scholar 

  57. Heylen AM, Jacobs A, Lybeer M, Prosst RL. The OTSC(R)-Clip in revisional endoscopy against weight regain after bariatric gastric bypass surgery. Obes Surg. 2011;21(10):1629–33.

    Article  PubMed  Google Scholar 

  58. Herron DM, Birkett DH, Thompson CC, et al. Gastric bypass pouch and stoma reduction using a transoral endoscopic anchor placement system: a feasibility study. Surg Endosc. 2008;22:1093–9.

    Article  PubMed  Google Scholar 

  59. Tang SJ, Olukoga CO, Provost DA, et al. Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos). Gastrointest Endosc. 2008;68:132–8.

    Article  PubMed  Google Scholar 

  60. Ryou M, Cantillon-Murphy P, Azagury D, et al. Smart Self-Assembling Magnets for Endoscopy (SAMSEN) for transoral endoscopic creation of immediate gastrojejunostomy (with video). Gastrointest Endosc. 2011;73(2):353–9.

    Article  PubMed  Google Scholar 

  61. Ahima RS, Qi Y, Singhal NS, et al. Brain adipocytokine action and metabolic regulation. Diabetes. 2006;55 suppl 2:S145–54.

    Article  PubMed  CAS  Google Scholar 

  62. Guijarro A, Suzuki S, Chen C, et al. Characterization of weight loss and weight regain mechanisms after Roux-en-Y gastric bypass in rats. Am J Physiol Regul Integr Comp Physiol. 2007;293:R1474–89.

    Article  PubMed  CAS  Google Scholar 

  63. Thompson CC, Jacobsen GR, Schroder GL, Horgan S. Stoma size critical to 12-month outcomes in endoscopic suturing for gastric bypass repair. Surg Obes Relat Dis. 2012;8(3):282–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA

    Nitin Kumar M.D.

  2. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Christopher C. Thompson M.D., M.Sc., F.A.C.G., F.A.S.G.E.

Authors
  1. Nitin Kumar M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher C. Thompson M.D., M.Sc., F.A.C.G., F.A.S.G.E.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher C. Thompson M.D., M.Sc., F.A.C.G., F.A.S.G.E. .

Editor information

Editors and Affiliations

  1. Harvard Medical School, Division of Gastroenterology,, Brigham and Women's Hospital, 75 Francis St, ASB2, Boston, 02115, Massachusetts, USA

    Christopher C. Thompson

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kumar, N., Thompson, C.C. (2013). Endoscopic Therapy for Weight Regain After Bariatric Surgery. In: Thompson, C. (eds) Bariatric Endoscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1710-2_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1710-2_18

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1709-6

  • Online ISBN: 978-1-4419-1710-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation