Endoscopic Sclerotherapy Induces Additional Weight Loss Initial Roux-en-Y Gastric Bypass

Background: Weight gain (WG) following initial weight loss (WL) success or inadequate initial WL (IWL) from Roux-en-Y gastric bypass (RNYGB) is a problem for many patients. Often, this may due to dilation of the gastrojejunostomy (GJ). Effective endoscopic management would avoid the morbidity of surgical revision. We hypothesized that endoscopic sclerotherapy (ES) of the GJ can achieve additional weight loss.
Methods: Patients with long-term WG or IWL were endoscopically evaluated for dilated GJ. ES was performed by circumferential injection of sodium morrhuate around the dilated GJ. WL was analyzed on a per procedure and per patient basis (to determine effectiveness of multiple procedures). Statistical analysis was performed via Wilcoxon tests.
Results: 14 patients underwent 20 ES. Follow-up ranged from 1 – 12 months. One patient was not available for follow-up. Examining WL on a per procedure basis, 8/19 did not yield weight loss. In the remaining 11, weight loss averaged 9.5 pounds (3.8% of total weight) per procedure (p < 0.001). For all 19 procedures, weight loss averaged 3.2 pounds per procedure (p > 0.05). Examining weight loss on a per patient basis, 6/13 patients did not have net weight loss. The remaining 7 patients had an average WL of 12.2 pounds (4.7% of total weight) per patient (p < 0.016). For all 13 patients, net weight loss averaged 4.3 pounds per patient (p > 0.05). Only one of four patients undergoing multiple procedures lost greater than one pound.
Conclusion: ES does yield WL in approximately half of the patients. Multiple ES do not seem to improve outcomes. ES may be a useful as first line therapy for patients with WG/IWL and dilated GJ.

Session: Podium Presentation

Program Number: S069

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