Treatment of dilated gastrojejunostomy with sclerotherapy.
BACKGROUND
Dilation of the gastrojejunostomy after gastric bypass may result in weight gain. Many surgical and medical treatments have met with poor results. A feasibility study of endoscopic sclerotherapy (ST) of the gastrojejunostomy was performed, based on the known risk of esophageal stricture in the treatment of esophageal varices.


METHODS
From 1991 to 2001, proximal Roux-en-Y gastric bypass (RYGBP) was performed on 685 patients, with a follow-up rate of 60% at 5 years. 20 patients were identified with dilated gastrojejunostomy (DGJ) by gastroscopy (EGD) performed for complaints of weight gain and marked increase in volume tolerance. Sclerotherapy of the gastrojejunostomy was performed during EGD. EGD was repeated 2 months after the sclerotherapy to measure the diameter of the anastomosis and observe any complications. Weight and sense of satiety were also measured, 2 and 6 months after ST. If necessary, the procedure was repeated to achieve a diameter of 10 mm.


RESULTS
Reducing the diameter of the gastrojejunostomy to 9-10 mm was achieved in all patients, with an average of 1.3 treatments per patient. 15 patients (75%) lost weight. The average weight loss was 5.8 kg (ranging from 0.5 to 17.3 kg) in 2 months.


CONCLUSIONS
Sclerotherapy successfully restores the desired anatomy of gastric bypass, but exercise and dietary discretion remain critical elements of sustained weight loss.
Department of Surgery, Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT 05403, USA. laurie.spaulding@brmednet.org
Laurie
L
Spaulding
D000328:Adult; D004108:Dilatation, Pathologic; D005240:Feasibility Studies; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015911:Sclerotherapy