Endoscopic revision of gastric bypass: Holy Grail or Epic fail?

Alberto S. Gallo, Christopher G. DuCoin, Martin A. Berducci, Diego Nino, Moneer Almadani, Bryan J. Sandler, Santiago Horgan, Garth R. Jacobsen

Research output: Contribution to journalArticle

Abstract

Background: Approximately 20–30 % of patients who undergo Roux-en-Y gastric bypass (RYGB) will not meet the goals of weight loss surgery. Revisional surgery is associated with higher morbidity compared to initial operative management, and results in terms of weight loss have been inconsistent. Endoscopic plication has been seen as a less invasive option, with encouraging initial results. The objective was to analyze the outcomes after Restorative Obesity Surgery, Endolumenal (ROSE) procedure. Methods: We retrospectively analyzed patients who underwent ROSE between 5/2008 and 11/2013. All patients had failure of weight loss or regain weight after RYGB. Demographics, operative data, and follow-up were recorded. Results: Twenty-seven patients underwent ROSE. One patient was excluded due to lack of follow-up. Twenty-five (96 %) patients were female. Mean time since initial RYGB was 11.9 ± 4.3 years. Mean initial weight and BMI were 236 ± 47 lb and 40.6 ± 8.1 kg/m2, respectively. Mean OR time was 77 ± 30 min. Preoperative average pouch length and stoma diameter were 6.8 ± 2.3 and 2.1 ± 0.7 cm, respectively. On average, 4 ± 1.6 stitches were placed. Final pouch length and stoma diameter were 3.4 ± 1.6 (50 % reduction) and 0.86 ± 0.4 cm (61 % reduction). A total of 12 (46 %) and seven (28 %) patients underwent EGD at 3 and 12 months postoperatively. The mean pouch length and stoma diameter were 5 ± 1.9 (26.5 % reduction) and 1.2 ± 0.7 cm (42.9 % reduction) at 3 months and 6.14 ± 1.6 (10 % reduction) and 2.2 ± 1.2 cm (4.7 % increase) at 12 months, respectively. The %EWL was 8.9, 9.3, 8, 6.7, −10.7, −13.5, −5.8, −4.5 at 3, 6, 12, 24, 36, 48, 60, and 72 months, respectively. Conclusion: Although endoscopic plication achieved the intended reduction in the pouch and stoma diameter at 3 months, these tend toward the preoperative diameter at 12 months. This anatomical failure and the lack of follow-up may explain why most patients failed to achieve sustainable weight loss.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Dec 16 2015
Externally publishedYes

Fingerprint

Gastric Bypass
Weight Loss
Obesity
Weights and Measures
Demography
Morbidity

Keywords

  • Endoscopic revision
  • Gastric bypass
  • NOTES
  • Obesity surgery
  • Revisional surgery
  • ROSE

ASJC Scopus subject areas

  • Surgery

Cite this

Gallo, A. S., DuCoin, C. G., Berducci, M. A., Nino, D., Almadani, M., Sandler, B. J., ... Jacobsen, G. R. (Accepted/In press). Endoscopic revision of gastric bypass: Holy Grail or Epic fail? Surgical Endoscopy and Other Interventional Techniques, 1-6. https://doi.org/10.1007/s00464-015-4699-3

Endoscopic revision of gastric bypass : Holy Grail or Epic fail? / Gallo, Alberto S.; DuCoin, Christopher G.; Berducci, Martin A.; Nino, Diego; Almadani, Moneer; Sandler, Bryan J.; Horgan, Santiago; Jacobsen, Garth R.

In: Surgical Endoscopy and Other Interventional Techniques, 16.12.2015, p. 1-6.

Research output: Contribution to journalArticle

Gallo, Alberto S. ; DuCoin, Christopher G. ; Berducci, Martin A. ; Nino, Diego ; Almadani, Moneer ; Sandler, Bryan J. ; Horgan, Santiago ; Jacobsen, Garth R. / Endoscopic revision of gastric bypass : Holy Grail or Epic fail?. In: Surgical Endoscopy and Other Interventional Techniques. 2015 ; pp. 1-6.
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title = "Endoscopic revision of gastric bypass: Holy Grail or Epic fail?",
abstract = "Background: Approximately 20–30 {\%} of patients who undergo Roux-en-Y gastric bypass (RYGB) will not meet the goals of weight loss surgery. Revisional surgery is associated with higher morbidity compared to initial operative management, and results in terms of weight loss have been inconsistent. Endoscopic plication has been seen as a less invasive option, with encouraging initial results. The objective was to analyze the outcomes after Restorative Obesity Surgery, Endolumenal (ROSE) procedure. Methods: We retrospectively analyzed patients who underwent ROSE between 5/2008 and 11/2013. All patients had failure of weight loss or regain weight after RYGB. Demographics, operative data, and follow-up were recorded. Results: Twenty-seven patients underwent ROSE. One patient was excluded due to lack of follow-up. Twenty-five (96 {\%}) patients were female. Mean time since initial RYGB was 11.9 ± 4.3 years. Mean initial weight and BMI were 236 ± 47 lb and 40.6 ± 8.1 kg/m2, respectively. Mean OR time was 77 ± 30 min. Preoperative average pouch length and stoma diameter were 6.8 ± 2.3 and 2.1 ± 0.7 cm, respectively. On average, 4 ± 1.6 stitches were placed. Final pouch length and stoma diameter were 3.4 ± 1.6 (50 {\%} reduction) and 0.86 ± 0.4 cm (61 {\%} reduction). A total of 12 (46 {\%}) and seven (28 {\%}) patients underwent EGD at 3 and 12 months postoperatively. The mean pouch length and stoma diameter were 5 ± 1.9 (26.5 {\%} reduction) and 1.2 ± 0.7 cm (42.9 {\%} reduction) at 3 months and 6.14 ± 1.6 (10 {\%} reduction) and 2.2 ± 1.2 cm (4.7 {\%} increase) at 12 months, respectively. The {\%}EWL was 8.9, 9.3, 8, 6.7, −10.7, −13.5, −5.8, −4.5 at 3, 6, 12, 24, 36, 48, 60, and 72 months, respectively. Conclusion: Although endoscopic plication achieved the intended reduction in the pouch and stoma diameter at 3 months, these tend toward the preoperative diameter at 12 months. This anatomical failure and the lack of follow-up may explain why most patients failed to achieve sustainable weight loss.",
keywords = "Endoscopic revision, Gastric bypass, NOTES, Obesity surgery, Revisional surgery, ROSE",
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T2 - Holy Grail or Epic fail?

AU - Gallo, Alberto S.

AU - DuCoin, Christopher G.

AU - Berducci, Martin A.

AU - Nino, Diego

AU - Almadani, Moneer

AU - Sandler, Bryan J.

AU - Horgan, Santiago

AU - Jacobsen, Garth R.

PY - 2015/12/16

Y1 - 2015/12/16

N2 - Background: Approximately 20–30 % of patients who undergo Roux-en-Y gastric bypass (RYGB) will not meet the goals of weight loss surgery. Revisional surgery is associated with higher morbidity compared to initial operative management, and results in terms of weight loss have been inconsistent. Endoscopic plication has been seen as a less invasive option, with encouraging initial results. The objective was to analyze the outcomes after Restorative Obesity Surgery, Endolumenal (ROSE) procedure. Methods: We retrospectively analyzed patients who underwent ROSE between 5/2008 and 11/2013. All patients had failure of weight loss or regain weight after RYGB. Demographics, operative data, and follow-up were recorded. Results: Twenty-seven patients underwent ROSE. One patient was excluded due to lack of follow-up. Twenty-five (96 %) patients were female. Mean time since initial RYGB was 11.9 ± 4.3 years. Mean initial weight and BMI were 236 ± 47 lb and 40.6 ± 8.1 kg/m2, respectively. Mean OR time was 77 ± 30 min. Preoperative average pouch length and stoma diameter were 6.8 ± 2.3 and 2.1 ± 0.7 cm, respectively. On average, 4 ± 1.6 stitches were placed. Final pouch length and stoma diameter were 3.4 ± 1.6 (50 % reduction) and 0.86 ± 0.4 cm (61 % reduction). A total of 12 (46 %) and seven (28 %) patients underwent EGD at 3 and 12 months postoperatively. The mean pouch length and stoma diameter were 5 ± 1.9 (26.5 % reduction) and 1.2 ± 0.7 cm (42.9 % reduction) at 3 months and 6.14 ± 1.6 (10 % reduction) and 2.2 ± 1.2 cm (4.7 % increase) at 12 months, respectively. The %EWL was 8.9, 9.3, 8, 6.7, −10.7, −13.5, −5.8, −4.5 at 3, 6, 12, 24, 36, 48, 60, and 72 months, respectively. Conclusion: Although endoscopic plication achieved the intended reduction in the pouch and stoma diameter at 3 months, these tend toward the preoperative diameter at 12 months. This anatomical failure and the lack of follow-up may explain why most patients failed to achieve sustainable weight loss.

AB - Background: Approximately 20–30 % of patients who undergo Roux-en-Y gastric bypass (RYGB) will not meet the goals of weight loss surgery. Revisional surgery is associated with higher morbidity compared to initial operative management, and results in terms of weight loss have been inconsistent. Endoscopic plication has been seen as a less invasive option, with encouraging initial results. The objective was to analyze the outcomes after Restorative Obesity Surgery, Endolumenal (ROSE) procedure. Methods: We retrospectively analyzed patients who underwent ROSE between 5/2008 and 11/2013. All patients had failure of weight loss or regain weight after RYGB. Demographics, operative data, and follow-up were recorded. Results: Twenty-seven patients underwent ROSE. One patient was excluded due to lack of follow-up. Twenty-five (96 %) patients were female. Mean time since initial RYGB was 11.9 ± 4.3 years. Mean initial weight and BMI were 236 ± 47 lb and 40.6 ± 8.1 kg/m2, respectively. Mean OR time was 77 ± 30 min. Preoperative average pouch length and stoma diameter were 6.8 ± 2.3 and 2.1 ± 0.7 cm, respectively. On average, 4 ± 1.6 stitches were placed. Final pouch length and stoma diameter were 3.4 ± 1.6 (50 % reduction) and 0.86 ± 0.4 cm (61 % reduction). A total of 12 (46 %) and seven (28 %) patients underwent EGD at 3 and 12 months postoperatively. The mean pouch length and stoma diameter were 5 ± 1.9 (26.5 % reduction) and 1.2 ± 0.7 cm (42.9 % reduction) at 3 months and 6.14 ± 1.6 (10 % reduction) and 2.2 ± 1.2 cm (4.7 % increase) at 12 months, respectively. The %EWL was 8.9, 9.3, 8, 6.7, −10.7, −13.5, −5.8, −4.5 at 3, 6, 12, 24, 36, 48, 60, and 72 months, respectively. Conclusion: Although endoscopic plication achieved the intended reduction in the pouch and stoma diameter at 3 months, these tend toward the preoperative diameter at 12 months. This anatomical failure and the lack of follow-up may explain why most patients failed to achieve sustainable weight loss.

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KW - Gastric bypass

KW - NOTES

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KW - ROSE

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