Peroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients.
BACKGROUND
Dumping syndrome is a well-described consequence of Roux-en-Y gastric bypass. Although the condition can benefit some patients with morbid obesity, a subset will develop intractable dumping syndrome characterized by symptomatic episodes with most meals. We describe the first series of patients successfully treated endoscopically for intractable dumping syndrome.


METHODS
Endoscopic gastrojejunal anastomotic reduction was performed in patients with intractable dumping syndrome after Roux-en-Y gastric bypass using a combination of argon plasma coagulation, endoscopic suturing, and fibrin glue. The technical feasibility of endoscopic anastomotic reduction and the clinical improvement in dumping symptoms were assessed by clinical follow-up.


RESULTS
Endoscopic anastomotic reduction was technically successful in 6 consecutive patients with a dilated gastrojejunal anastomosis and intractable dumping syndrome. One patient reported hematemesis 2 days after the procedure that was treated endoscopically. No other significant complications occurred. Complete and persistent resolution of the dumping symptoms was achieved in all patients, with a median follow-up of 636 days.


CONCLUSIONS
Endoscopic anastomotic reduction appears technically feasible and safe and might be a minimally invasive treatment option for patients who experience intractable dumping symptoms after Roux-en-Y gastric bypass. Additional studies are needed to determine the long-term efficacy of this procedure.
Fernández-Esparrach
Gloria
G
Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Lautz
David B
DB
Thompson
Christopher C
CC
D000714:Anastomosis, Surgical; D004377:Dumping Syndrome / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D015390:Gastric Bypass / Q000009:adverse effects*; D005746:Gastric Emptying / Q000502:physiology; D006801:Humans; D007583:Jejunum / Q000503:physiopathology / Q000601:surgery; D013270:Stomach / Q000503:physiopathology / Q000601:surgery; D013536:Suture Techniques