Obesity Surgery

, Volume 21, Issue 10, pp 1629–1633 | Cite as

The OTSC®-Clip in Revisional Endoscopy Against Weight Gain After Bariatric Gastric Bypass Surgery

  • Alex Marie Florent Heylen
  • Anja Jacobs
  • Monika Lybeer
  • Ruediger L. Prosst
New Concepts


The maintenance of the restrictive component of the Fobi pouch gastric bypass is essential for permanent weight control. Dilatation of the pouch-outlet and of the pouch itself is responsible for substantial weight gain by an increased volume per meal and binge-eating due to the rapid emptying. An endoscopic over-the-scope clip (OTSC®; Ovesco AG, Tübingen, Germany) was applied in 94 patients following gastric bypass and unintended weight gain by dilated gastro-jejunostomy to narrow the pouch-outlet. The OTSC®-clip application was safe and efficient to reduce the pouch-outlet in all cases. Best clinical results were obtained by narrowing the gastro-jejunostomy by placing two clips at opposite sites, hence reducing the outlet of more than 80%. Preferably, the clip approximated the whole thickness of the wall to avoid further dilatation of the anastomosis. Between surgery and OTSC®-clip application the mean BMI dropped from 45.8 (±3.6) to 32.8 (±1.9). At the first follow-up about 3 months (mean 118 days, ±46 days) after OTSC®-clip application the mean BMI was 29.7 (±1.8). At the second follow-up about 1 year (mean 352 days, ±66 days) after OTSC®-clip application the mean BMI was 27.4 (±3.8). The OTSC®-clip for revisional endoscopy after gastric bypass is reliable and effective in treating weight gain due to a dilated pouch-outlet with favorable short- and midterm results.


OTSC®-clip Fobi pouch gastric bypass Dilated pouch-outlet Dilated gastro-jejunostomy Bariatric surgery 


Conflict of interest



  1. 1.
    Fobi MA. Placement of the GaBP ring system in the banded gastric bypass operation. Obes Surg. 2005;15(8):1196–201.PubMedCrossRefGoogle Scholar
  2. 2.
    Branca F, Nikogosian H, Lobstein T. The challenge of obesity in the WHO European Region and the strategies for response. Copenhagen: WHO Publications; 2007.Google Scholar
  3. 3.
    Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009 Apr 15;(2).Google Scholar
  4. 4.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.PubMedCrossRefGoogle Scholar
  5. 5.
    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. Gastrointest Endosc. 2009;70(3):440–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Loewen M, Barba C. Endoscopic sclerotherapy for dilated gastro-jejunostomy of failed gastric bypass. Surg Obes Relat Dis. 2008;4(4):539–42.PubMedCrossRefGoogle Scholar
  8. 8.
    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(2):240–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Thompson CC, Slattery J, Bundga ME, et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y bypass: a possible new option for patients with weight regain. Surg Endosc. 2006;20(11):1744–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Schweitzer M. Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients. J Laparoendosc Adv Surg Tech A. 2004;14(4):223–6.PubMedGoogle Scholar
  11. 11.
    Ryou M, Mullady DK, Lautz DB, et al. 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.PubMedCrossRefGoogle Scholar
  12. 12.
    von Renteln D, Schmidt A, Vassiliou MC, et al. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy. 2009;41(6):481–6.CrossRefGoogle Scholar
  13. 13.
    Kirschniak A, Traub F, Kueper MA, et al. Endoscopic treatment of gastric perforation caused by acute necrotizing pancreatitis using over-the-scope clips: a case report. Endoscopy. 2007;39(12):1100–2.PubMedCrossRefGoogle Scholar
  14. 14.
    Kirschniak A, Kratt T, Stüker D, et al. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007;66(1):162–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Repici A, Arezzo A, De Caro G, et al. Clinical experience with a new endoscopic over-the-scope clip system for use in the GI tract. Dig Liver Dis. 2009;41(6):406–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Arezzo A, Repici A, Kirschniak A, et al. New developments for endoscopic hollow organ closure in prospective of NOTES. Minim Invasive Ther Allied Technol. 2008;17(6):355–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Schurr MO, Arezzo A, Ho CN, et al. The OTSC clip for endoscopic organ closure in NOTES: device and technique. Minim Invasive Ther Allied Technol. 2008;17(4):262–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Alex Marie Florent Heylen
    • 1
  • Anja Jacobs
    • 1
  • Monika Lybeer
    • 1
  • Ruediger L. Prosst
    • 2
  1. 1.St.-Ursula HospitalKuringenBelgium
  2. 2.Proctological Institute Stuttgart, Medicine and Medical Technology ConsultingStuttgartGermany

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