Endoscopic and Radiographic Changes Following Incisionless Revisional Surgery for Treatment of Post Roux-en-Y (rygb) Stoma and Pouch Dilatation

Introduction: Upper gastrointestinal contrast studies and upper endoscopy are useful tools for screening and evaluation of gastrointestinal integrity before and after bariatric surgery. They also can be useful in documenting the anatomical changes following these interventions. We wanted to evaluate the immediate and intermediate post-operative changes associated with an incisionless approach to revisional surgery for post-RYGB stoma and pouch dilatation utilizing the EndoSurgical Operating System™ (EOS).
Methods: In this video, we illustrate creation of tissue folds using expandable anchors,and correlate the resulting stomaplasty and gastroplasty with pre- and post-operative UGI contrast radiographs and endoscopic images from selected patients who underwent endolumenal revisional stoma and pouch reduction with the EOS System. Patients qualified for this procedure with confirmation of significant weight regain subsequent to their bypass nadir, and evidence of post-bypass stoma/pouch dilatation on screening endoscopy.
Results: Endoscopic measurements confirmed significant stoma and pouch size reduction at the end of the endolumenal revisional procedure. UGI contrast study within one day post-op demonstrated an overall decrease in pouch and stoma size as compared to the preoperative UGI as well as evidence of reduced gastric emptying time. The decreased pouch and stoma size and reduced gastric emptying was also evident on UGI at two weeks post-procedure, confirming the reduction was produced by the plications and not simply immediate post-procedural edema. Endoscopic images obtained at three months confirmed anchor durability and sustained reduction of gastric pouch and stoma .
Conclusion: Fluoroscopically and endoscopically evaluating gastric pouch and stoma size before and after this incisionless revisional surgery may provide patients and clinicians useful tools to confirm procedural success and durability.

Session: Video Channel

Program Number: V050

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