Endoscopic Gastrojejunal Revisions Following Gastric Bypass: Lessons Learned in More Than 100 Consecutive Patients.

BACKGROUND: Weight regain and dumping after Roux-en-Y gastric bypass (RYGB) are long-term challenges thought to be due to dilation of the gastrojejunal anastomosis. The aim of this study was to analyze the feasibility, safety, and outcomes of endoscopic gastrojejunal revisions (EGRs) after its introduction in a tertiary bariatric surgery center.

METHODS: From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing EGR with the OverStitch suturing device. Demographics, procedure details, and outcomes were recorded.

RESULTS: There were 107 patients (M:F = 29:78) treated with 133 EGR procedures for weight regain (n = 81), dumping syndrome (n = 13), or both (n = 13) with mean age 47.3 years (R 22.0-72.9) and mean BMI 32.9 kg/m2 (R 22.2-49.8) at time of procedure. Mean procedure time was 17.8 min (R 12-41), with median 1 suture used (R 1-2). No intra-operative or 30-day complications were recorded. Mean follow-up time was 9.2 months (R 1-26.8). Patients lost a mean of 4.1, 5.8, and 8.0 kg at 3, 6, and 12 months, respectively, after the procedure. Weight loss outcomes were significantly better when two compared to one suture was used (p = 0.036), and for patients with higher starting BMI (p = 0.047). For patients with dumping syndrome, 90-100% had treatment response after one or two EGRs.

CONCLUSION: EGR is feasible and safe for weight regain and dumping syndrome after RYGB. It can stabilize weight regain and improve dumping symptoms. Around 20% of patients will need repeat EGR within 1 year to achieve sufficient narrowing of the anastomosis.