A. Valencia1, D. E. Azagury1, L. Voller1, T. E. Mokhtari1, P. Pradhan1, N. Strauch1, S. Koontz1, J. Morton1 1Stanford University,Surgery,Palo Alto, CA, USA
Introduction:
Roux-en-Y Gastric Bypass (RYGB) remains the gold standard in bariatric surgery and can lead to significant, sustainable weight loss. However, weight regain remains a long-term risk and very few options are available in the setting of significant weight regain. Previous studies have demonstrated a relationship between increased gastrojejunal stoma diameter and impaired weight loss/weight regain. In this setting, endoscopic suturing may be a useful tool in order to help patients struggling with weight regain and recurrence of their comorbidities. We present a review of full thickness endoscopic gastro-jejunal outlet reductions (EGOR) performed at our institution and resulting weight loss, comorbidity resolution, and perioperative outcomes.
Methods:
Thirty-eight patients underwent EGOR after RYGB and were included in this retrospective analysis of a prospective bariatric database. Pre-EGOR data collected included patients’ demographic information, body mass index (BMI), and percent excess weight loss (%EWL). Perioperative data were recorded. Postoperative complications, BMI, %EWL, and comorbidities were collected at 3, 6 and 12 months. Dichotomous and continuous variables were examined by Chi-Square analysis and Student’s t-test, respectively. Fisher’s exact test was used for categorical variables if cell counts were less than five.
Results:
Average time between RYGB and EGOR was 120.6 ± 67.2 months [range: 37 – 436]. Average BMI at the time of EGOR was 42.0 ± 9.9 kg/m2 [range: 32.7 – 55.2]. Mean operative time was 70.4 minutes [range: 25 – 177]. All cases were performed as outpatient procedures. Average BMI decreased from 42.0 ± 9.9 kg/m2 preoperatively (n=38) to a nadir of 34.4 ± 5.4 kg/m2 (p=0.0038) 6 months after EGOR. At both 3- and 6-months postop, all patients had lost weight from their preop baseline. At 12 month post-operative visit, the weight of five patients either returned or surpassed baseline weight. Of the seven patients with recurrent diabetes, three experienced remission at the 12-month visit. Recurrent hypertension was resolved in four of nine patients, hyperlipidemia was resolved in six of eight patients, and six of eight patients reported significant improvements in sleep apnea at the 12-month post-operative visit.
Conclusion:
This study is one of very few reports regarding outcomes for EGOR after RYGB. Our results show that EGOR can be performed as an outpatient procedure with an excellent safety profile. This procedure may lead to very significant weight loss in select patients, but results vary between individuals and more so beyond 6 months. Importantly, impact on recurrence of comorbidities, including diabetes, is significant even in the setting of modest weight loss. Further studies are needed to assess the long-term sustainability of weight loss following EGOR and to evaluate methods to identify which patients might benefit most from this intervention.