Endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass.
BACKGROUND
Roux-en-Y gastric bypass is an excellent option for weight loss in the morbidly obese. Unfortunately, some patients do have weight regain or insufficient weight loss. Revisional bariatric surgery is not without risk. Less invasive techniques may provide alternative treatments for patients that regain weight or have insufficient weight loss. This video demonstrates a technique of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass.


METHODS
The technique is applied to patients who have had weight regain or insufficient weight loss following gastric bypass. Patients who have lost the feeling of satiety, undergone reeducation and recounseling of dietary changes, and have documented dilated gastrojejunostomy on upper endoscopy and/or a barium study are offered this technique. If the gastojejunostomy is larger than 12 mm, sodium morrhuate is injected with an endoscopic needle circumferentially.


RESULTS
The gastrojejunostomy is injected with 6-30 cc of sodium morrhuate. By visual inspection, the anastomosis usually appears smaller after the procedure. Most patients report a subjective feeling of satiety after the endoscopic sclerotherapy. Reinjection after 3 months has been performed in some patients. Except mild nausea, the patients have experienced no morbidity or mortality from the procedure.


CONCLUSIONS
Endoscopic sclerotherapy may offer an alternative treatment for dilated gastrojejunostomy after gastric bypass. The technique described in the video is a relatively easy, safe method that may become the first line of therapy in patients who have a dilated gastrojejunostomy and have lost the feeling of satiety after gastric bypass with an associated weight gain.
Madan
Atul K
AK
Division of Laparoendoscopic and Bariatric Surgery, Department of Surgery, University of Miami, Miami, Florida 33136, USA. atulkmadan@yahoo.com
Martinez
Jose M
JM
Khan
Khurram A
KA
Tichansky
David S
DS
D004108:Dilatation, Pathologic; D004724:Endoscopy; D015390:Gastric Bypass; D006801:Humans; D007267:Injections; D009765:Obesity / Q000601:surgery; D012086:Reoperation; D012527:Satiation / Q000502:physiology; D015911:Sclerotherapy / Q000379:methods*; D012976:Sodium Morrhuate / Q000008:administration & dosage; D017211:Treatment Failure
D012976:Sodium Morrhuate