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Endoscopic gastrojejunostomy revision is more effective than medical management alone to address weight regain after RYGB

  • Endoluminal Surgery
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Abstract

Background

Weight regain after bariatric roux-en-y gastric bypass affects up to 30% of individuals. Revisional surgery is risky, and is typically avoided in favor of dietary and psychological management. Endoscopic gastrojejunostomy revision is a low-morbidity, outpatient procedure that may be more effective than medical management alone for regain after gastric bypass.

Methods

Two patient cohorts were retrospectively assembled. Both groups had gastric bypass, regained weight, and were cleared for revision by their surgeon, dietician, and psychologist. The revision group underwent the procedure, and the no-revision group did not, typically due to insurance issues. Weights from pre-bypass to 2 years post-revision, obesity-related comorbidities, and intraoperative factors were collected and analyzed.

Results

There were 41 patients included in the revision group and 14 in the no-revision group. Up to the time of revision procedure, body mass index, and % excess weight loss between groups were similar. After revision, the groups diverged over a 2-year period, with improvement seen in the revision group and worsening in the no-revision group. The revision group showed overall improvement in comorbidities compared to the no-revision group. Analysis of intraoperative factors suggests that gastric pouch restriction in addition to stoma diameter reduction may promote weight loss.

Conclusions

In this retrospective study, endoscopic revision provided significantly greater weight loss compared to medical management alone. Results show that revision can help resolve obesity-related comorbidities. Analysis of intraoperative factors suggests that pouch reduction at time of stoma revision may improve weight loss.

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Funding

There was no external funding for this project.

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Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, 5841 S Maryland Avenue, Chicago, IL, 60637, USA

    H. Mason Hedberg

  2. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60601, USA

    H. Mason Hedberg, Alexander Trenk, John G. Linn, JoAnn Carbray & Michael B. Ujiki

  3. Department of Biostatistics and Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA

    Kristine Kuchta

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  1. H. Mason Hedberg
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  2. Alexander Trenk
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  6. Michael B. Ujiki
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Corresponding author

Correspondence to H. Mason Hedberg.

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Disclosures

Dr. Linn receives consulting fees from Medtronic, Dr. Ujiki receives consulting fees from Medtronic, GORE, and Apollo Endosurgery, Drs. Hedberg, Trenk and Ms. Kuchta and Carbray have nothing to disclose.

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Hedberg, H.M., Trenk, A., Kuchta, K. et al. Endoscopic gastrojejunostomy revision is more effective than medical management alone to address weight regain after RYGB. Surg Endosc 32, 1564–1571 (2018). https://doi.org/10.1007/s00464-018-6073-8

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  • DOI: https://doi.org/10.1007/s00464-018-6073-8

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