Short-term outcomes of endoscopic gastro-jejunal revisions for treatment of dumping syndrome after Roux-En-Y gastric bypass

  • Catherine Tsai
  • Rudolf Steffen
  • Ulf Kessler
  • Hans Merki
  • Joerg ZehetnerEmail author
2019 SAGES Oral Dynamic



Dumping syndrome is a known long-term complication of Roux-en-Y gastric bypass (RYGB). Most cases can be avoided with dietary and lifestyle changes. Severe dumping is characterized by multiple daily episodes with significant impact on quality-of-life. As dumping correlates with rapid pouch emptying through a dilated gastro-jejunal anastomosis (GJA), the aim was to assess endoscopic gastro-jejunal revisions (EGR) regarding feasibility, safety, and outcome.


From January 2016 to August 2018, we reviewed the electronic records of all patients with dumping syndrome undergoing EGR with the Apollo OverStitch suturing device (Apollo Endosurgery, Austin, Texas, USA). Demographics, procedure details, and outcome variables were recorded. Sigstad questionnaire was administered before and after surgery to assess symptomatic response.


There were 40 patients (M:F = 13:27) treated with EGR for dumping. Mean procedure time was 18.5 min (12–41) with a median number of 1 suture (range 1–3) used. Mean anastomotic diameter was 22.6 mm (R 18–35) at the beginning and 6.2 mm (R 4–13) at the end of the procedure, with 100% technical success in narrowing the GJA. There were no intra-operative or 30-day complications. Repeat EGR was required in 9 patients (22.5%) for persistent/recurrent dumping. Two patients (5%) required a laparoscopic pouch revision. For patients with minimum 1-month follow-up who were treated only endoscopically, 33/37 (89.2%) had improved or resolved symptoms during the follow-up period. Mean follow-up time was 12.5 months (R1-33.8). Survey responses were available for 25/34 (73.5%) patients. Mean Sigstad score decreased from 13.9 (R 0–28) pre-operatively to 8.6 (R 0–28) after EGR.


EGR of the dilated GJA is a highly effective treatment option for dumping syndrome after RYGB. Due to its endoluminal approach, it is a feasible and safe procedure, and effective for immediate symptom resolution in most patients. In some patients, repeat narrowing of the anastomosis is necessary for the maintenance of symptom resolution.

Graphic Abstract


Endoscopy Dumping Endosurgery Gastric bypass 



We would like to thank the patients for allowing us to be a part of their care and providing the information for this study.

Compliance with ethical standards


Catherine Tsai, Rudolf Steffen, Ulf Kessler, Hans Merki, and Joerg Zehetner have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 113164 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Catherine Tsai
    • 1
  • Rudolf Steffen
    • 1
  • Ulf Kessler
    • 1
  • Hans Merki
    • 1
  • Joerg Zehetner
    • 1
    Email author
  1. 1.Department of Visceral SurgeryHirslanden Clinic Beau-SiteBerneSwitzerland

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