Does StomaphyX Treat Weight Gain and Comorbidity Recurrence Following RYGB?

B Sung, MD, N Leva, BS, S Ahmed, BS, N Lodhia, BS, John M Morton, MD, MPH

Stanford University

Introduction. StomaphyX is a natural orifice transluminal endoscopic procedure to reduce gastric anastomosis and pouch size following RYGB. We characterize the safety and efficacy of this procedure to treat insufficient weight loss and recurrence of comorbidities.

Methods. At an academic institution, between 2008 and 2011, 19 patients underwent StomaphyX. BMI, comorbidities, and complications before and after RYGB and StomaphyX were recorded.

Results. Of 19 patients, 89% were women. Mean demographics are as follows: age at RYGB – 42.5 years; age at StomaphyX – 48.2 years; 70.3 months between procedures; index BMI – 52.3 kg/m2; nadir BMI – 32.0 kg/m2 or 83.6% of index excess weight lost (%EWL). Mean preoperative BMI at the time of the StomaphyX was 39.3 kg/ m2, which represents a mean gain of 7.3 BMI units, or 33% of index %EWL. Prior to gastric bypass, 58% of patients had hypertension, 42% had diabetes, 37% had GERD, and 63% had obstructive sleep apnea (OSA); patients had a mean 4.1 preoperative comorbidities. At one-year s/p RYGB, 64% of patients had resolution of hypertension (27% had improved hypertension), 100% had resolution of their diabetes, 57% had resolution of GERD (29% had improvement of GERD), and 92% had resolution of OSA (8% improved). At the time of the StomaphyX, patients had an average of 3.4 comorbidities. One patient had a new onset of diabetes since RYGB and 62% of patients with prior diabetes had a recurrence. 63% of patients with resolved OSA had recurrence. Of the 19 patients, only 1 patient suffered a complication (perforated ulcer). At 3, 6, and 12 months post StomaphyX, patients respectively lost an average of 27, 27, and 18% EWL. Following StomaphyX, 12 month comorbidity improvements included HTN: 40% resolved, 20% improved; DM: 67% resolved, 33% improved; GERD: 40% resolved; Sleep Apnea: 75% resolved, 12.5% improved

Conclusion. StomaphyX patients lose 27% EWL at 6 months. Despite weight regain at one-year postop, improvement in comorbidities is substantial. The natural orifice approach of StomaphyX and low complication rates makes it a safe alternative to revisional bariatric surgery for treating insufficient weight loss and recurrence of comorbidities s/p RYGB.

Session: Poster Presentation

Program Number: P581