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Correlation Between Gastrojejunal Anastomosis Diameter, Distensibility Index, and Weight Regain After Roux-en-Y Gastric Bypass

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Abstract

Introduction

Gastrojejunal anastomosis (GJA) dilation is an independent predictor of weight regain (WR) after Roux-en-Y gastric bypass (RYGB). However, the role of planimetric measurements in this context remains unknown.

Methods

This is a retrospective cohort study including adult RYGB patients who underwent a diagnostic endoscopy with Endoflip assessment of the GJA. We excluded patients in the early postoperative period and those with abnormal endoscopic findings (marginal ulcers and gastro-gastric fistulas).

Results

Thirty-four patients were initially included. Endoscopic GJA diameter had a moderate positive correlation with WR (r=+0.438, p=0.011). However, after excluding the 7 patients with GJA> 30 mm, there was no significant correlation. There was a moderate agreement between the EndoFLIP-GJA diameter at 60mL and endoscopic diameter (ICC=0.576, p=0.049). The distensibility index (DI) showed a consistent moderate negative correlation with WR. Considering the maximum DI at 40 ml, we found a cutoff of DI = 7 mm2/mmHg that split the sample in two significantly different populations in terms of WR (67.4% vs. 43.2%, p=0.04).

Conclusion

Visual estimation of the GJA diameter correlates with EndoFLIP at 60mL. In the subset of patients with GJA ≤ 30 mm, more distensible GJAs are associated with lower rates of WR. Larger studies are needed to confirm this correlation and to validate its utility for clinical management.

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Acknowledgements

The authors acknowledge Dr. Donna Maria Abboud and Dr. Karim Al Annan for their contributions to the study.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA

    Farah Abdul Razzak, Anthony Kerbage, Vitor O. Brunaldi, Rudy Mrad, Tala Mahmoud, Khushboo Gala, Eric J. Vargas, Andrew Storm & Barham Abu Dayyeh

  2. Gastroenterology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Vitor O. Brunaldi

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Omar Ghanem

Authors
  1. Farah Abdul Razzak
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  2. Anthony Kerbage
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  3. Vitor O. Brunaldi
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  4. Rudy Mrad
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  5. Tala Mahmoud
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  6. Khushboo Gala
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  7. Eric J. Vargas
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  8. Andrew Storm
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  9. Omar Ghanem
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  10. Barham Abu Dayyeh
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Contributions

BKA was involved in study design, conceptualization, study conduct, patient recruitment, data collection, data interpretation, statistical analysis, writing of manuscript, creation of figures, and drafting and critical review of the manuscript. FA, AK, VOB , RM, and TM were involved in study conduct, data collection, writing the manuscript, literature search, data interpretation, and critical review of the manuscript. FA and AK were responsible for statistical analysis and development of figures. KG, TM, EV, ACS, and OM were involved in data interpretation and critical review of the manuscript. BKA, FA, VOB, and RM fully accessed and verified the underlying data. All authors verify that this study was done per protocol and vouch for data accuracy and completeness.

Corresponding author

Correspondence to Barham Abu Dayyeh.

Ethics declarations

Ethical Approval

This study has been approved by the appropriate institutional research ethics committee.

Consent to Participate

Informed consent was obtained from all participants in the study.

Conflict of Interest

ACS reports institutional research grants from Boston Scientific, Enterasense, Endogenex; consulting fees from Olympus; consulting fees and research grants from Endo-TAGSS, and Apollo Endosurgery; Participation in Data Safety Monitoring Board with GI Dynamics, and ERBE. BKA reports consultant roles with Endogenex, Endo-TAGSS, Metamodix, and BFKW; consultant and grant/research support from USGI, Apollo Endosurgery, Spatz Medical, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; Speaker roles with Olympus, Johnson and Johnson; and speaker and grant/research support from Medtronic, Endogastric solutions. The remaining authors declare that there is no conflict of interest.

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Key Points

• Likewise literature, we found positive correlation between endoscopic GJA diameter and WR.

• Correlation between endoscopic GJA and WR lost significance for patients with GJA < 30 mm.

• Endoscopic GJA diameter correlates with EndoFLIP GJA diameter at 60 ml BV.

• Distensibility index of the GJA and WR were found to have a negative correlation.

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Razzak, F.A., Kerbage, A., Brunaldi, V.O. et al. Correlation Between Gastrojejunal Anastomosis Diameter, Distensibility Index, and Weight Regain After Roux-en-Y Gastric Bypass. OBES SURG 33, 4042–4048 (2023). https://doi.org/10.1007/s11695-023-06918-3

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  • DOI: https://doi.org/10.1007/s11695-023-06918-3

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