Catherine Tsai, Ulf Kessler, Rudolf Steffen, Hans Merki, Joerg Zehetner. Clinic Beau-Site
Background: Dumping occurs in up to 25% of patients after a Roux-en-Y gastric bypass (RYGB) for morbid obesity. While dumping can be avoided in most cases with dietary modifications, severe sequelae of hypoglycemia such as loss of consciousness can severely impact quality-of-life. One of the etiologies of dumping syndrome is rapid emptying of a carbohydrate-rich meal through a dilated gastro-jejunal anastomosis (GJA). Revision of the GJA has the potential to restrict passage of food and thus prevent dumping. However, laparoscopic or open revisional bariatric surgeries are associated with increased morbidity and mortality. The aim of this study was to assess endoscopic gastro-jejunal revisions (EGR) for the treatment of dumping syndrome.
Methods: We performed a retrospective review of all RYGB patients with dumping syndrome receiving EGR at our institution from January 2016 to August 2018. The Apollo Overstitch system (Apollo Endosurgery, Austin, Texas, USA) was used to narrow the GJA using an interrupted suture technique. Demographic details, procedure details and outcome variables were recorded. Sigstad score were obtained in patients with a minimum of 3 months follow-up to assess for symptomatic response.
Results: We identified 40 patients (M:F=13:27) treated with EGR for dumping syndrome. Mean age was 47.1 years (R 22.0-75.4) and mean BMI was 31.2 kg/m2 (R 22.2-39.8). Mean procedure time was 19.7 minutes (R 12-41) with a median of 1 suture (R 1-3) used. Mean anastomotic diameter was 22.5mm (R 18-35) at the beginning of the procedure and 6.3mm (R 4-13) at the end, with 100% technical success in narrowing the GJA. There were no complications (bleeding, re-intervention, dilation) recorded within 30 days. Mean follow-up time was 14.3 months (R 0.3-31.9). Repeat EGR was required in 9 patients (22.9%) and laparoscopic pouch revision for one patient (2.5%) for persistent or recurrent symptoms. Of 29 patients with minimum 3-month follow-up, 25 (86.2%) had symptomatic response (Sigstad score decrease from mean 13.8 to 8.8), and four (13.8%) had persistent symptoms (Sigstad score from mean 17.7 to 13.7).
Conclusion: EGR to narrow the GJA is a highly effective treatment option for dumping syndrome after RYGB. The procedure is feasible, safe, and effective for immediate symptom resolution in nearly all patients, with about a fifth of patients requiring a second EGR for symptomatic response.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94942
Program Number: S074
Presentation Session: Bariatric II – Revisions
Presentation Type: Podium