Endoscopic Stomal Revisions With the Overstitch Device – A Multi-Center Experience

Garrett Friedman, MD, Jan-Holly L Nicolas, MD, Renzo Garberoglio, MD, Kamran Samakar, MD, Marcos J Michelotti, MD, Keith R Scharf, DO. Loma Linda University Medical Center

Background: Weight regain or inadequate weight loss after Roux-en-Y gastric bypass (RYGB) has been associated with dilation of the gastrojejunal anastomosis. Endoluminal approaches for stoma reduction have been hypothesized as a strategy to improve weight loss after RYGB. This study examines a two-institution experience with one such procedure, using the OverStitch (Apollo Endosurgery, Austin TX) device for endoluminal revision of the gastrojejunal stoma.

Objective: To examine the safety and efficacy of OverStitch endoluminal revision of the gastrojejunal stoma as a salvage procedure after RYGB.

Methods: A retrospective review of an IRB-approved prospective database identified 9 patients that underwent endoscopic stomal revision at either Loma Linda University Medical Center or Loma Linda Veterans Administration Hospital between July 2013 and September 2014. Percent excess body weight loss was the primary measured endpoint.

Results: Nine consecutive patients underwent endoscopic stomal revisions using the Overstitch device; five were performed at Loma Linda Veterans Administration Hospital and four at Loma Linda University Medical Center. All patients demonstrated weight loss at their first post-operative visit, ranging between 2.3 and 18.2 kg (mean time to first post-op visit = 17.5 days). Average percent excess body weight loss (%EBWL) at the first post-operative visit was 14.3%. At the time of submission for publication (mean follow-up time = 273 days), average %EBWL was 19.8% (average % excess BMI loss = 19.4%). Complications following intervention included one patient with new onset hypoglycemia amenable to diet modification. There was no mortality.

Conclusion: In our series, patients experienced modest short-term weight loss results, which is consistent with previously published series. (Mikami et al. published their results with endoscopic gastric pouch plication utilizing Stomaphyx in 2010, showing 10.6% EBWL at 1 month and 13.1% at 2 months after intervention, while Horgan et al’s. multi-center study represents perhaps the largest patient group of this kind, showing 18% EBWL at 6 months.) This weight loss, however, is likely multifactorial, as the procedure not only reduces the size of the GJ stoma but also represents a “reset” of the patient’s diet and psychological milieu. Our experience suggests that endoluminal stomal revisions using Overstitch provide modest but acceptable short-term weight loss and should be considered a safe and efficacious option for bypass patients with inadequate weight loss or weight gain. Long-term studies are required to determine whether endoscopic revision provides truly durable weight loss to patients.