Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video).
BACKGROUND
Some patients are thought to regain weight after gastric bypass surgery because of dilation of the gastrojejunal anastomosis (GJA) and/or gastric pouch.


OBJECTIVE
To assess the technical success and safety of an endoscopic procedure, Revision Obesity Surgery Endoscopic (ROSE), using an endoscopic operating system for the placement of tissue anchors to reduce the diameter of the GJA and size of the gastric pouch.


METHODS
Prospective case series.


METHODS
Brigham and Women's Hospital, Boston, Massachusetts.


METHODS
A total of 20 patients who had regained a mean of 13 kg after gastric bypass, with a dilated pouch and GJA on screening endoscopy, underwent the ROSE procedure.


METHODS
Technical success, reduction in size of the GJA and gastric pouch, and early complications. Early weight loss was also assessed.


RESULTS
Technical success was achieved in 17 of 20 (85%) patients with an average reduction in stoma diameter of 16 mm (65% reduction) and an average reduction in pouch length of 2.5 cm (36% reduction). The mean weight loss in successful cases was 8.8 kg at 3 months. There were no major complications.


CONCLUSIONS
Single-center case series with a relatively small number of patients and short duration of follow-up, which was inadequate for assessing durable long-term weight loss.


CONCLUSIONS
The ROSE procedure is technically feasible and appears safe. Data from this series suggest that the ROSE procedure is effective in reducing not only the size of the GJA but also the gastric pouch and may provide an endoscopic alternative for weight regain in gastric bypass patients.
Mullady
Daniel K
DK
Division of Gastroenterology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Lautz
David B
DB
Thompson
Christopher C
CC
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D004108:Dilatation, Pathologic / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D018579:Patient Selection; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss