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Efficacy and safety of transoral outlet reduction via endoscopic suturing in patients with weight regain after a surgical Roux-en-Y gastric bypass

2018; Arán Ediciones; Volume: 110; Linguagem: Inglês

10.17235/reed.2018.5419/2017

2340-4167

Eduardo Espinet Coll, Javier Nebreda Durán, Gontrand López-Nava Breviere, Manoel Galvão Neto, José Antonio Gómez Valero, S Bacchiddu, Carmen Vila Lolo, Patricia Díaz Galán, Inmaculada Bautista-Castaño, A Juan-Creix Comamala,

Dysphagia Assessment and Management

Introduction: many patients that undergo bariatric surgery (Roux-en-Y gastric bypass [RYGB]) may regain some of their weight lost over time.A transoral outlet reduction (TORe) with endoscopic suture could be a valid alternative in these patients.Methods: this was a retrospective initial series of 13 consecutive patients with weight regain after RYGB and a dilated gastro-jejunal anastomosis (> 15 mm).TORe was performed using an endoscopic transmural suture device (OverStitch-Apollo®), which was used to reduce the anastomosis aperture and also to treat the gastric pouch.The initial data of feasibility, safety and weight loss are described with a limited follow-up of six months.Results: there was a mean maximum weight loss of 37.69 kg after RYGB and a subsequent average regain of 21.62 kg.The mean anastomosis diameter was 36 mm (range 20-45) which was reduced to 9 mm (range 5-12) (75% reduction), with an average of 2.5 sutures.The mean pouch size was 7.2 cm (range 2-10), which decreased to 4.7 cm (range 4-5) (34.72% reduction), with an average of 2.7 sutures.The mean weight loss six months after TORe was 12.29 kg, a weight loss of 56.85% of the weight regained after RYGB.No complications related to the procedure were recorded.Conclusions: endoscopic suture reduction of the dilated gastro-jejunal anastomosis and the gastric pouch seems a feasible and safe option in our limited initial experience.With a multidisciplinary approach and a short term follow-up, this seems to be a minimally invasive and effective option to control weight regain after RYGB.