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Endoscopic revision of gastric bypass: Holy Grail or Epic fail?

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Abstract

Background

Approximately 20–30 % of patients who undergo Roux-en-Y gastric bypass (RYGB) will not meet the goals of weight loss surgery. Revisional surgery is associated with higher morbidity compared to initial operative management, and results in terms of weight loss have been inconsistent. Endoscopic plication has been seen as a less invasive option, with encouraging initial results. The objective was to analyze the outcomes after Restorative Obesity Surgery, Endolumenal (ROSE) procedure.

Methods

We retrospectively analyzed patients who underwent ROSE between 5/2008 and 11/2013. All patients had failure of weight loss or regain weight after RYGB. Demographics, operative data, and follow-up were recorded.

Results

Twenty-seven patients underwent ROSE. One patient was excluded due to lack of follow-up. Twenty-five (96 %) patients were female. Mean time since initial RYGB was 11.9 ± 4.3 years. Mean initial weight and BMI were 236 ± 47 lb and 40.6 ± 8.1 kg/m2, respectively. Mean OR time was 77 ± 30 min. Preoperative average pouch length and stoma diameter were 6.8 ± 2.3 and 2.1 ± 0.7 cm, respectively. On average, 4 ± 1.6 stitches were placed. Final pouch length and stoma diameter were 3.4 ± 1.6 (50 % reduction) and 0.86 ± 0.4 cm (61 % reduction). A total of 12 (46 %) and seven (28 %) patients underwent EGD at 3 and 12 months postoperatively. The mean pouch length and stoma diameter were 5 ± 1.9 (26.5 % reduction) and 1.2 ± 0.7 cm (42.9 % reduction) at 3 months and 6.14 ± 1.6 (10 % reduction) and 2.2 ± 1.2 cm (4.7 % increase) at 12 months, respectively. The %EWL was 8.9, 9.3, 8, 6.7, −10.7, −13.5, −5.8, −4.5 at 3, 6, 12, 24, 36, 48, 60, and 72 months, respectively.

Conclusion

Although endoscopic plication achieved the intended reduction in the pouch and stoma diameter at 3 months, these tend toward the preoperative diameter at 12 months. This anatomical failure and the lack of follow-up may explain why most patients failed to achieve sustainable weight loss.

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Authors and Affiliations

  1. Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA

    Alberto S. Gallo, Christopher G. DuCoin, Martin A. Berducci, Diego F. Nino, Moneer Almadani, Bryan J. Sandler, Santiago Horgan & Garth R. Jacobsen

  2. Baptist Health Louisville, 4001 Kresge Way Suite 200, Louisville, KY, 40207, USA

    Alberto S. Gallo

Authors
  1. Alberto S. Gallo
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  2. Christopher G. DuCoin
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  3. Martin A. Berducci
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  4. Diego F. Nino
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  5. Moneer Almadani
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  6. Bryan J. Sandler
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  7. Santiago Horgan
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  8. Garth R. Jacobsen
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Correspondence to Alberto S. Gallo.

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Disclosures

Drs. Alberto S. Gallo, Christopher G. DuCoin, Martin A. Berducci, Diego F. Nino, Moneer Almadani, Bryan J. Sandler, Santiago Horgan, and Garth R. Jacobsen have no conflicts of interest or financial ties to disclose.

Additional information

Presented at the SAGES 2015 Annual Meeting, April 15–18, 2015, Nashville, Tennessee.

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Gallo, A.S., DuCoin, C.G., Berducci, M.A. et al. Endoscopic revision of gastric bypass: Holy Grail or Epic fail?. Surg Endosc 30, 3922–3927 (2016). https://doi.org/10.1007/s00464-015-4699-3

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  • DOI: https://doi.org/10.1007/s00464-015-4699-3

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