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BALTIMORE -- Endoscopic gastrojejunostomy revision (EGJR) appeared to be effective for arresting or reversing weight regain following Roux-en-Y gastric bypass surgery, according to a retrospective study presented here.
Among patients who regained considerable weight over a 7.5-year period after initial bypass surgery, those undergoing EGJR had no further regain during the succeeding 5 years, according to Zachary Callahan, MD, of NorthShore University Health System in Evanston, Illinois, who presented the findings at the . Mean weight even dipped a small amount after EGJR.
Callahan emphasized prior research has shown "endoscopic gastrojejunostomy revision is more effective than medical management alone to address weight regain after RYGB."
"Weight gain after gastric bypass is a challenging problem. These patients despite having major alterations to their anatomic and physiologic ability to ingest and absorb food still regained weight. It's also important to remember that the surgical alternative to EGJR is a traditional bariatric revision, which is well-known to be high risk with many complications," Callahan told attendees.
His group evaluated 70 patients who had EGJR using a full thickness endoscopic suturing tool at NorthShore University HealthSystem. Median follow-up in the cohort was 3 years after EGJR. Patients' mean age was 51 when they had EGJR; 90% were women. Those for whom was the primary indication for the operation were excluded, as were those lacking any follow-up data.
Prior to the initial bypass procedure, patients had an average weight of 150.5 kg (331.79 lbs) and average BMI of 55. Maximal weight loss averaged 61.7 kg (136.0 lbs), with mean 67.6% loss of excess body weight loss over 2.2 years.
However, patients in the cohort subsequently regained an average of 27.5 kg (60.6 lbs); average BMI was 42.3 at the time of consult for EGJR.
The average initial stoma was 30.6 mm, and the average final stoma had a diameter of 5.8 mm. Not surprisingly, "patients with greater stoma reduction lost more weight," Callahan highlighted, with a clear benefit for patients with at least 85% reduction in stoma size. Results also suggested that purse-string suturing had longer-lasting results than interrupted suturing.
Callahan pointed out that complications did sometimes ensue. These included delayed emptying, perforation, and intraoperative and postoperative bleeding, although these only occurred in one or two patients each. Also, EGJR did not seem to decrease patients' medical comorbidities. Among the latter were diabetes mellitus (n=20), hypertension (n=30), hyperlipidemia (n=18), and obstructive sleep apnea (n=29).
All but 10 of the 70 patients were discharged the same day they underwent EGJR. Mean duration of stay for those admitted was 32.5 hours.
Callahan noted that limitations of the study included its retrospective design. Also, patients were lost over time, such that their numbers were small with lengthier follow-up (n=18 at 5 years).
Disclosures
Callahan reported no relevant disclosures.
Primary Source
Society of American Gastrointestinal and Endoscopic Surgeons 2019 Meeting
Callahan ZM, et al "Five-year results of endoscopic gastrojejunostomy revision (transoral outlet reduction) for weight gain after gastric bypass" SAGES 2019.