Endoscopic Gastrojejunal Stomal Revision After Weight Regain A Single Academic Center Experience

Abstract

Background: Bariatric surgery is associated with significant sustained weight loss, with the Roux-en-Y gastric bypass being one of the most effective procedures. Expected weight loss after gastric bypass is 70% of excess body weight at the 2-year postoperative time point. However, up to 35% of patients who have undergone gastric bypass experience weight recidivism by 10 years post-procedure. Possible anatomic causes of weight regain include gastrojejunal stomal dilation, gastrogastric fistula, and gastric pouch dilation. Several salvage procedures have been described for patients that have failed medical management. These include gastric plication, gastric banding, and endoscopic revision. Our study examined the safety and efficacy of endoluminal revision of the gastrojejunal stoma as a salvage procedure for patients with weight regain after Roux-en-Y Gastric Bypass surgery. Method(s): Consecutive endoluminal revision (OverStitch, Apollo Endosurgery, Inc) cases were identified between 2013-2016. A retrospective review was performed with data abstraction at preoperative and postoperative time points. Data points included age and gender, and for each time point patient's BMI and number of days since surgery were calculated. Ideal body weight was calculated with a body mass index (BMI) 25 for each time point. Excess body weight was then calculated using the difference between current weight and ideal body weight. Stoma dilation was considered for all gastrojejunal stomas with a diameter greater then 15mm, with the goal of stoma reduction to 10mm. Result(s): 16 consecutive cases were identified with postoperative data points. Characteristics of the patient population included a mean age of 51.2 years, 68.7% females, mean preoperative BMI of 41.4 and mean excess body weight of 45kg. Our primary end point was percent excess body weight lost (%EBWL). Mean follow up was 23.3 weeks (range 1.5 284.5 weeks). Mean postoperative BMI was 38.79. Mean %EBWL was 20.66% (range 2.04% - 97.72%).. Linear regression revealed significant excess body weight lost after endoluminal revision of dilated gastrojejunal stoma (R2 = 0.77, F = 90.32, p < 0.0001; GraphPad). No patients experienced morbidity or mortality. Conclusion(s): Although our sample size is small with short term follow-up, endoluminal revision for a dilated gastrojejunal stoma in our study shows %EBWL of 20.66% at a mean follow-up at 6 months. In patients for which the identifiable cause of their weight regain is stomal dilation, endoluminal revision is a promising salvage procedure to achieve weight loss as well as reconnect the patient with the bariatric surgery team.