title: The OTSC®-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery.
abstract: The maintenance of the restrictive component of the Fobi pouch gastric bypass is essential for permanent weight control. Dilatation of the pouch-outlet and of the pouch itself is responsible for substantial weight gain by an increased volume per meal and binge-eating due to the rapid emptying. An endoscopic over-the-scope clip (OTSC®; Ovesco AG, Tübingen, Germany) was applied in 94 patients following gastric bypass and unintended weight gain by dilated gastro-jejunostomy to narrow the pouch-outlet. The OTSC®-clip application was safe and efficient to reduce the pouch-outlet in all cases. Best clinical results were obtained by narrowing the gastro-jejunostomy by placing two clips at opposite sites, hence reducing the outlet of more than 80%. Preferably, the clip approximated the whole thickness of the wall to avoid further dilatation of the anastomosis. Between surgery and OTSC®-clip application the mean BMI dropped from 45.8 (±3.6) to 32.8 (±1.9). At the first follow-up about 3 months (mean 118 days, ±46 days) after OTSC®-clip application the mean BMI was 29.7 (±1.8). At the second follow-up about 1 year (mean 352 days, ±66 days) after OTSC®-clip application the mean BMI was 27.4 (±3.8). The OTSC®-clip for revisional endoscopy after gastric bypass is reliable and effective in treating weight gain due to a dilated pouch-outlet with favorable short- and midterm results.
authors.affiliation: St.-Ursula Hospital, Kuringersteenweg 521, 3511, Kuringen, Belgium. alexheylen@hotmail.com
authors.forename: Alex Marie Florent
authors.initials: AM
authors.lastname: Heylen
authors.forename: Anja
authors.initials: A
authors.lastname: Jacobs
authors.forename: Monika
authors.initials: M
authors.lastname: Lybeer
authors.forename: Ruediger L
authors.initials: RL
authors.lastname: Prosst
mesh_terms: D004108:Dilatation, Pathologic / Q000601:surgery; D004724:Endoscopy; D005260:Female; D015390:Gastric Bypass / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D013525:Surgical Instruments; D015430:Weight Gain
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