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Transoral Outlet Reduction to Tackle Weight Regain After Roux-en-Y Gastric Bypass: a Single Center Initial Experience

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Abstract

Background

Long-term failure after Roux-en-Y gastric bypass (RYGB) is well known and occurs in 10–15% of patients according to the literature. Causes are multifactorial and dilatation of the gastro-jejunal anastomosis (GJA) is only one of these. A transoral outlet reduction (TORe) with endoscopic sutures to reinstall more restriction could be a valid and safe alternative to reduce regained weight after failed gastric bypass surgery. The objective of this article is to describe our single-center experience and discuss the adverse events of the technique.

Objectives

To describe our single-center case series and adverse events after TORe for weight regain after RYGB.

Methods

We report a case series of 20 patients referred due to weight regain after RYGB with a dilated GJA. TORe was performed using an endoscopic full-thickness suture device (Apollo OverStitch®) to reduce the diameter of the GJA and the volume of the gastric reservoir. Prospectively collected data on technical feasibility, safety and efficacy are described with a median follow-up of 22 (6–38) months.

Results

Mean BMI was 44.5 kg/m2 at the time of RYGB. Postoperative nadir BMI was 27,7 kg/m2. The average time to TORe was 12.1 years after initial RYGB. Patients regained a mean 45.9% of excess body weight loss (EWL) before TORe and had a mean preprocedural BMI of 35.3 kg/m2. The aim was to reduce the aperture of the GJA to 5 mm which was done with a mean of 1.7 sutures and 3.5 stitches. The mean absolute weight loss was 13 kg and BMI reduction was 3.9 kg/m2 after 6 months. After a median follow-up of 22 months, a BMI of 31.4 kg/m2 was observed. Dumping symptoms resolved in four of our patients 6 weeks after TORe. Procedural adverse events were nausea and vomiting, sore throat, mild transient abdominal pain, diarrhea and constipation. All of them were treated conservatively. Due to a lack of weight loss, a suture failure was assumed in two of our patients. We describe one case of postprocedural mediastinitis, presumably due to a distal esophageal perforation, treated with a laparoscopic drainage without clinical evidence for perforation.

Conclusions

Endoscopic TORe by narrowing the dilated GJA appears to be an efficient and safe minimal invasive option to tackle weight regain after RYGB and should be more used in clinical practice.

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Abbreviations

RYGB:

Roux-en-Y gastric bypass

TORe:

Transoral outlet reduction

GJA:

Gastrojejunal anastomosis

AE:

Adverse event

APMC:

Argon plasma mucosal coagulation

%EBWL:

Percent excess body weight loss

TWL:

Total weight loss

References

  1. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36. https://doi.org/10.1007/s11695-012-0864-0.

    Article  PubMed  Google Scholar 

  2. Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA - J Am Med Assoc. 2015;313(1):62–70. https://doi.org/10.1001/jama.2014.16968.

    Article  CAS  Google Scholar 

  3. Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg. 2019;29(3):782–95. https://doi.org/10.1007/s11695-018-3593-1.

    Article  PubMed  Google Scholar 

  4. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32. https://doi.org/10.1007/s11695-015-1657-z.

    Article  CAS  PubMed  Google Scholar 

  5. Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55. https://doi.org/10.1056/nejmoa1700459.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52. https://doi.org/10.1056/nejmoa066254.

    Article  Google Scholar 

  7. Nicoletti CF, de Oliveira BAP, de Pinhel MAS, et al. Influence of excess weight loss and weight regain on biochemical indicators during a 4-year follow-up after Roux-en-Y gastric bypass. Obes Surg. 2015;25(2):279–84. https://doi.org/10.1007/s11695-014-1349-0.

    Article  PubMed  Google Scholar 

  8. Changela K. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: techniques and efficacy. World J Gastrointest Endosc. 2016;8(4):239. https://doi.org/10.4253/wjge.v8.i4.239.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Callahan ZM, Su B, Kuchta K, et al. Five-year results of endoscopic gastrojejunostomy revision (transoral outlet reduction) for weight gain after gastric bypass. Surg Endosc. 2020;34(5):2164–71. https://doi.org/10.1007/s00464-019-07003-6.

    Article  PubMed  Google Scholar 

  10. Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc. 2016;83(4):776–9. https://doi.org/10.1016/j.gie.2015.08.039.

    Article  PubMed  Google Scholar 

  11. Conaty EA, Novak S, Avitia R, et al. Endoscopic gastrojejunal revision (transoral outlet reduction) for persistent hypoglycemia after gastric bypass. Obes Surg. 2019;29(11):3773–5. https://doi.org/10.1007/s11695-019-04113-x.

    Article  PubMed  Google Scholar 

  12. Kumar N. Weight loss endoscopy: development, applications, and current status. World J Gastroenterol. 2016;22(31):7069–79. https://doi.org/10.3748/wjg.v22.i31.7069.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jaruvongvanich V, Vantanasiri K, Laoveeravat P, et al. Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis. Gastrointest Endosc. 2020;92(6):1164-1175.e6. https://doi.org/10.1016/j.gie.2020.07.013.

    Article  PubMed  Google Scholar 

  14. Relly R, Mati S, Cohen Aviv N, et al. Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome. Surg Endosc. 1234;35:6846–6852. https://doi.org/10.1007/s00464-020-08190-3.

  15. Jirapinyo P, Kumar N, AlSamman MA, et al. Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointest Endosc. 2020;91(5):1067–73. https://doi.org/10.1016/j.gie.2019.11.044.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. General and Abdominal Surgery Department, AZ Delta Hospital, Deltalaan 1, 8800, Roeselare/Torhout, Belgium

    Louis Vansteenbrugge, Sébastien Strypstein, Isabelle Debergh & Bart Smet

  2. Abdominal Surgery, Sint-Andries Hospital, Tielt, Belgium

    Mehrdad Biglari

Authors
  1. Louis Vansteenbrugge
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  2. Sébastien Strypstein
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  3. Mehrdad Biglari
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  4. Isabelle Debergh
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  5. Bart Smet
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Corresponding author

Correspondence to Louis Vansteenbrugge.

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Key points

• Dilation of the gastrojejunal anastomosis is a possible mechanism of weight regain

• Reducing the anastomosis leads to weight loss

• Mean loss of 13 kg after TORe procedure

• Resolution of dumping symptoms after TORe

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Vansteenbrugge, L., Strypstein, S., Biglari, M. et al. Transoral Outlet Reduction to Tackle Weight Regain After Roux-en-Y Gastric Bypass: a Single Center Initial Experience. OBES SURG 33, 1646–1651 (2023). https://doi.org/10.1007/s11695-023-06580-9

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  • DOI: https://doi.org/10.1007/s11695-023-06580-9

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