REDUCE – Over-the-scope clip-based endoscopic anastomotic reduction in patients with dumping-syndrome after gastric bypass

Aims Dumping syndrome represents a common complication after roux-en-Y gastric bypass surgery (RYGB). Rapid passage of food into the small intestine through a dilated gastrojejunal anastomosis is thought to be crucial in the pathophysiology both for early and late dumping. In this prospective multicenter study, the anti-dumping effect of a new clip-based endoscopic system (BARS) for reduction of the gastrojejunal anastomotic diameter was evaluated.

Methods Twenty-three consecutive patients suffering from dumping syndrome after RYGB at three tertiary care centers in Germany were treated with BARS. The primary endpoint was technical success (= reduction of anastomotic diameter by at least 70%). Secondary endpoints included procedural data and adverse events. Moreover, changes of Dumping symptom scores, improvement of early and late dumping in modified oral glucose tolerance test (mod oGTT) and anastomotic diameter after 12weeks were evaluated.

Results The cohort consisted of mainly female patients (83%) at a mean age of 41.6±8.4 years. All patients had been pretreated with dietary restrictions, 78% had been treated with acarbose. Mean procedural time was 40min±16min with the BARS procedure itself lasting 14min±13min. In 87% of the patients, the procedure was performed under conscious sedation. Application of the clip was successful in all cases. Mean anastomotic diameter was reduced from 38.0 mm (± 11.9) to 8.9 mm (± 3.5mm; -77%) at baseline (p<0.001). In two patients, the spacekeeper balloon did not inflate properly, which resulted in a subtotal closure of the anastomosis in one patient, but could be managed conservatively. At week 12, median Sigstad-Score decreased from 17,5 (13-21 IQR) to 5 (0-11 IQR; p<0.001)) as well as the anastomotic diameter was still significantly reduced from 40mm (15-25 IQR) to 20mm (6-15 IQR; p=0.004; -50%). Modified oGTT demonstrated abolished early dumping in 50% of the patients, and in 18% patients with late dumping at 12 weeks. As a side effect, median BMI decreased significantly from 30.6 (28-35.6 IQR) to 29.25 (26.7-33.4 IQR; p=0.001)

Conclusions Anastomotic reduction with BARS for treatment of dumping syndrome is feasible and safe. Clinical effectiveness was shown by significant improvements in Sigstad scores and mod oGTT, especially in patients with early dumping.

Publication History

Article published online:
27 March 2025