TRANSORAL OUTLET REDUCTION WITH SEMI-CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSA DISSECTION IS SUPERIOR TO ARGON PLASMA COAGULATION

Aims:

Roux-en-Y gastric bypass (RYGB) is a standard bariatric and metabolic procedure to induce weight-loss. Years after the intervention, a dilated gastrojejunal anastomosis (GJA) leads to weight regain or dumping syndrome. Recently, transoral outlet reduction (TOR) to GJA-diminution has been established by endoscopic suturing after tissue ablation with argon plasma coagulation (APC). However, rupture of sutures before scarring can lead to recurrent dilation of GJA. In this study, we compared a semi-circulated endoscopic submucosa dissection (ESD) as a novel approach for its superiority over APC before TOR.

Methods:

Data of patients who underwent APC-TOR or ESD-TOR were prospectively collected and retrospectively analyzed. The main objectives were reduction in GJA diameter and ruptured sutures. Technical success, complications, total weight loss (TWL), percent of total and excess weight loss (% TWL and % EWL) at 3 and 12 months, were assessed. Fisher's exact test, Student's t-test, Chi-Square-test and regression analyses were performed.

Results:

Forty-one patients with comparable baseline characteristics were enrolled (APC-TOR: 26, ESD-TOR: 15). ESD-TOR resulted in significantly fewer ruptured sutures (20% vs. 69%, p = 0.004) and a higher reduction of GJA (major: 20% vs. 0%, minor: 54% vs. 37%, no: 13% vs. 58%, p = 0.015) after 3 months. ESD-TOR was also identified as prediction parameter for fewer broken sutures and larger GJA reduction. TWL, % TWL or % EWL revealed no significant differences between both groups. Technical efficacy, examination time and rate of complications were comparable.

Conclusions:

ESD-TOR resulted in a significantly higher reduction in GJA diameter and lower risk of ruptured sutures compared to APC-TOR.