TRANSORAL OUTLET REDUCTION FOR WEIGHT REGAIN AFTER GASTRIC BYPASS: ONE YEAR FOLLOW-UP

Aims:

Enlargement of gastrojejunal anastomosis is associated with weight regain in patients with Roux-en-Y gastric bypass (RYGB). Endoscopic transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain. The objective of this study was to evaluate the safety and the efficacy in weight loss and quality of life after TORe.

Methods:

Patients with at least 50% of weight regain and enlarged gastric outlet after RYGB treated at our centre were retrospectively identified from a prospectively collected database. Endoscopic outlet reduction was performed with Overstitch (Apollo-Endosurgery). Before suturing the outlet rims were cauterized with pulsed Argon Plasma Coagulation on 40 Watts,1 l/min (VIO 300D, ERBE Elektromedizin GmbH). Follow-up was done at 1,3,6 and 12 months. The quality of life was evaluated according to the Quality Of Life Scale (QOLS).

Results:

Thirty-three patients (29 female, mean age 43.7) underwent TORe from January 2015 to April 2017. Baseline mean BMI was 37.9 (range 31 – 50). Mean number of 2.3 stitches per patient were placed (range 2 – 4) on the level of the gastric outlet. After suturing the patency of the redone outlet was tested with a standard gastroscope. There were 2 (6%) complications: one patient developed fever due to a small retrogastric collection and was treated with antibiotics, while one patient had a gastric perforation that required urgent surgery. Mean hospital stay was 2.4 days (range 1 – 10).

Thirty patients completed the follow up at 12 months. Three patients were lost during the follow-up. Mean weight loss at 12 months was 14.8 kg. Mean BMI was 32 and the % EWL was 34.5 at 1 year. Only two patients regained weight compared to baseline. All the patients reported satiety after 1 month, which was confirmed by 37.5% after 12 months follow-up In addition, over 50% of the study population had an improvement quality of life in terms of physical activity, relationships and dietary habits.

Conclusions:

In our experience TORe was a safe and effective procedure in patients with weight regain after RYGB, with stable promising results even in the long-term follow-up.