Background and study aims: A dilated gastrojejunal anastomosis (GJA) is thought to be associated with weight
regain in patients with Roux-en-Y gastric bypass (RYGB). Due to a high rate of perioperative
morbidity, surgical revision is not generally performed. The aim of this study was
to assess the technical feasibility, safety, and early outcomes of a procedure using
a commercially available endoscopic suturing device to reduce the diameter of the
GJA.
Patients and methods: This was a retrospective analysis of 25 consecutive patients who underwent transoral
outlet reduction (TORe) for dilated GJA and weight regain. An endoscopic suturing
device was used to place sutures at the margin of the GJA in order to reduce its aperture.
On chart review, clinical data were available at 3, 6, and 12 months.
Results: Patients had regained a mean of 24 kg from their weight loss nadir and had a mean
body mass index of 43 kg/m2 at the time of endoscopic revision. Average anastomosis diameter was 26.4 mm. Technical
success was achieved in all patients (100 %) with a mean reduction in anastomosis
diameter to 6 mm (range 3 – 10 mm), representing a 77.3 % reduction. The mean weight
loss in successful cases was 11.5 kg, 11.7 kg, and 10.8 kg at 3, 6, and 12 months,
respectively. There were no major complications.
Conclusion: This case series demonstrated the technical feasibility, safety, and efficacy of
performing gastrojejunostomy reduction using a commercially available endoscopic suturing
device. This technique may represent an effective and minimally invasive option for
the management of weight regain in patients with RYGB.
