title: Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision.
abstract: BACKGROUND
  Obesity affects more than 30% of the U.S. population and is associated with the development of life-threatening complications. Numerous therapeutic approaches to the problem have been advocated, including low-calorie diets, anoretic drugs, behavior modifications, and exercise therapy. The only treatment proven to be effective in the long-term management of morbid obesity is surgical intervention. Complications of bariatric surgery include stomal stenosis and/or ulcer and stomal dilation (secondary to overeating). The latter complication can result in a gain of previously lost weight.
  
  
  OBJECTIVE
  To determine the effect of endoscopic injection by using a sclerosant (sodium morrhuate) to induce stomal stenosis in patients who present with stomal dilatation complicated by weight gain.
  
  
  METHODS
  Bariatric patients with a large gastric stoma were treated with sodium morrhuate stomal injection. Diameters of the stoma were followed at repeat endoscopy. Weight loss at scheduled clinic visits were compared with pretherapy weights.
  
  
  METHODS
  Twenty-eight patients (10 men, 18 women; age range, 27-58 years), after bariatric surgery with GI bypass, were referred with weight gain after initial weight loss. Weight gain was believed to be the result of a large gastric stoma.
  
  
  METHODS
  Treatment included injection of sodium morrhuate (1-2 mL circumferentially) surrounding the stoma. A total of 1 to 3 injection sessions were performed in an attempt to achieve a stoma diameter of 1.2 cm or smaller.
  
  
  METHODS
  Treatment success was defined as a decrease of stoma size to <or=12 mm and weight loss >or=75% of the weight the patient gained after establishing a steady state post bariatric surgery weight.
  
  
  RESULTS
  A total of 2.3 injection sessions were performed. Successful endotherapy was achieved in 18 of 28 patients (64%). One patient developed symptoms of stomal stenosis, which required 2 separate balloon dilating sessions. No other complications were encountered.
  
  
  CONCLUSIONS
  Retrospective case series.
  
  
  CONCLUSIONS
  Endoscopic injection of sodium morrhuate surrounding the dilated gastric stoma complicating bariatric surgery appears to be a successful, less-invasive therapeutic alternative to surgical revision.
authors.affiliation: Department of Medicine, Division of Gastroenterology, St. Luke's Medical Center, St. Francis Hospital, Milwaukee, Wisconsin 53219, USA.
authors.forename: Marc F
authors.initials: MF
authors.lastname: Catalano
authors.forename: Goran
authors.initials: G
authors.lastname: Rudic
authors.forename: Alfred J
authors.initials: AJ
authors.lastname: Anderson
authors.forename: Thomas Y
authors.initials: TY
authors.lastname: Chua
mesh_terms: D000328:Adult; D004108:Dilatation, Pathologic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D012976:Sodium Morrhuate / Q000008:administration & dosage*; D054047:Surgical Stomas / Q000473:pathology*; D015430:Weight Gain
chemical_list: D012597:Sclerosing Solutions; D012976:Sodium Morrhuate