Zachary M Callahan, MD, Bailey S Su, MD, Kristine M Kuchta, MS, John G Linn, MD, Joann A Carbray, BS, Woody Denham, MD, Stephen P Haggerty, MD, Michael B Ujiki, MD. Northshore University Healthsystem
INTRODUCTION: The study aim is to determine if patients who have undergone Endoscopic Gastrojejunostomy Revision (EGJR) maintain sufficient weight loss up to five years post operatively. Although Roux-en-Y Gastric Bypass (RYGB) has been shown to be an effective weight loss intervention, weight recidivism has prompted the advent of EGJR. Outcome data at two or more years after revision is lacking and the long-term weight loss result of EGJR is unknown.
METHODS AND PROCEDURES: This is a retrospective review of a prospectively collected quality database that includes patients who underwent EGJR with a full thickness endoscopic suturing device between April 2009 and July 2017. Percent of excess body weight loss (%EBWL) was calculated using weight on day of consult as baseline. The paired t-test and McNemar’s test were used to compare weight and comorbidities between preoperative and postoperative time points.
RESULTS: A total of sixty patients regained 40.8 ± 27.8% of the weight lost after gastric bypass. On day of revision, BMI was 41.0 ± 7.4 and weight was 249.9 ± 48.1 lbs. At 6 months, weight loss was 24.1 ± 26.8 lbs or 19.3 ± 20.8 %EBWL; at 1 year, weight loss was 22.1 ± 30.7 lbs or 16.2 ± 22.9 %EBWL; at 2 years, weight loss was 15.2 ± 30.9 lbs or 11.3 ± 25.5 %EBWL; at 3 years, weight loss was 7.6 ± 20.4 lbs or 4.9 ± 16.6 %EBWL; at 4 years, weight loss was 3.1 ± 24.1 lbs or 0.8 ± 21.4 %EBWL; at 5 years, weight loss was 16.0 ± 43.6 lbs or 10.3 ± 26.2 %EBWL. There were no complications and all patients went home on day of procedure with one exception. At two years, weight regain was arrested in 61% of the cohort. The mean number of HTN medications required decreased from 0.9±1.2 on revision day to 0.6±0.9 at six months (p=0.0701) and 0.8±1.0 at one year (p=0.0371) post revision. The proportion of patients with GERD, HLD, and DM did not increase or decrease over this time period. Median follow up was 3 years (range 6 mo-9 years).
CONCLUSIONS: Weight loss after EGJR is sustained at up to five years after revision and successfully arrests weight gain in the majority of patients. This weight loss seems to have a positive effect on medical co-morbidities demonstrated by a decrease in the number of HTN medications patients required at six months and one year.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93930
Program Number: S076
Presentation Session: Bariatric II – Revisions
Presentation Type: Podium