Endoscopic ultrasound-guided bypass reversal in patients with Roux-en-Y gastric bypass and postprandial reactive hypoglycaemic syndrome: Promising interim results of a prospective proof-of-concept study

Aims Postprandial reactive hypoglycaemic syndrome (PPRHS) is a common complication of Roux-en-Y gastric bypass (RYGB) surgery. A surgical bypass reversal is proposed to severe refractory cases but could lead to recurrence of obesity and the related health issues. We aim to investigate whether endoscopic ultrasound (EUS)-assisted placement of a large diameter lumen-apposing metal stent (LAMS) between the stomach pouch and the excluded stomach is an effective alternative to surgery in RYGB patients with invalidating PPRHS refractory to conservative treatment.

Methods This is an interim analysis of a prospective proof-of-concept study in RYGB patients with severe PPRHS. After informed consent, they undergo EUS-assisted placement of a LAMS with a luminal diameter of 20 mm and a saddle length of 10 mm between the gastric pouch and the excluded stomach. Prospective follow-up is foreseen for 1 year. The main outcomes of interest are technical success, clinical success, and adverse events. Technical success is defined as the successful placement of the LAMS in the desired position. Clinical success is defined as resolution of PPRHS-related symptoms as reported by patients. Quality of life (QoL) before and after treatment is assessed with a visual analogue scale (VAS). The AGREE classification is used to grade adverse events.

Results This interim analysis includes data from 6 RYGB patients (all women, mean age 44 years [range 34-56], mean BMI 22 [range 18–28]) with a median follow-up of 211 days [range 68–365 days]. Technical success was achieved in all patients, with a mean procedural duration of 18 minutes [range 10–38]. All patients could be discharged from the hospital the same day. Clinical success was seen in 5/6 patients, with a fast resolution of PPRHS-related symptoms and an associated improvement in QoL. One patient did not respond to the treatment and is currently under investigation to rule out other causes of hypoglycemia. Adverse events occurred in 3 of the 6 patients (50%), all classified as minor. Two patients experienced temporary mild abdominal discomfort. One patient experienced an increase in reflux-associated symptoms, well-controlled by proton pump inhibitors. Importantly, the mean weight gain during follow-up was only 0.8 kg (range -3 to 4 kg).

Conclusions EUS-guided LAMS placement between the stomach pouch and the excluded stomach appears to be a promising minimally invasive alternative to surgical gastric bypass reversal in RYGB patients with severely invalidating PPRHS. Interim analysis shows high technical and clinical success rates, without serious adverse events or significant weight gain.

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Artikel online veröffentlicht:
27. März 2025