title: Endoscopic findings and outcomes of revisional procedures for patients with weight recidivism after gastric bypass.
abstract: BACKGROUND
  Significant weight regain occurs for 10% to 20% of patients after Roux-en-Y gastric bypass (RYGB). Potential causative factors include anatomic abnormalities such as enlargement of the gastric pouch and gastrojejunostomy (GJ). This report describes endoscopic findings for patients referred for investigation of weight regain and presents the outcomes of revisional therapy for patients with abnormal anatomy.
  
  
  METHODS
  To evaluate gastric pouch and stoma size, RYGB patients referred for weight regain underwent upper endoscopy. A GJ was defined as enlarged if it had a diameter greater than 2 cm in any dimension, and a pouch was defined as enlarged if its length exceeded 6 cm long or its width exceeded 5 cm. Patients with abnormal anatomy who subsequently underwent revisional procedures were arbitrarily categorized into three groups based on the interval from RYGB to endoscopic evaluation: less than 5 years (group 1), 5 to 10 years (group 2), longer than 10 years (group 3). The percentage of regained weight lost (%RWL) after revision was compared between the groups.
  
  
  RESULTS
  In this study, 205 RYGB patients (176 women with a mean age of 47 ± 10 years and a current body mass index [BMI] of 43.4 ± 8.4 kg/m(2)) were evaluated. The mean time from primary RYGB was 6.9 ± 3.7 years, and the increase in BMI from its nadir was 9.78 ± 5.80 kg/m(2). Abnormal endoscopic findings (n = 146, 71.2%) included large GJ (n = 86, 58.9%), large pouch (n = 42, 28.8%), or both (n = 18, 12.3%). Of the 205 patients, 51 (24.9%) underwent a revisional surgical or endoluminal procedure. At a mean follow-up assessment 13 months after revision, group 1 (n = 12) had a mean %RWL of 103% ± 89.3%, and 62% of these patients lost all their regained weight. The mean %RWL was 45% ± 12.6% in group 2 (n = 30) and 40% ± 13.6% in group 3 (n = 9).
  
  
  CONCLUSIONS
  Endoscopy is a valuable tool for evaluating weight regain after bariatric surgery that can identify abnormal post-RYGB anatomy in a majority of patients. Revisional procedures to restore normal RYGB anatomy appear to be most successful if performed within 5 years after the primary procedure.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH 44195, USA. yimchap@ccf.org
authors.forename: Panot
authors.initials: P
authors.lastname: Yimcharoen
authors.forename: Helen M
authors.initials: HM
authors.lastname: Heneghan
authors.forename: Manish
authors.initials: M
authors.lastname: Singh
authors.forename: Stacy
authors.initials: S
authors.lastname: Brethauer
authors.forename: Philip
authors.initials: P
authors.lastname: Schauer
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
mesh_terms: D000704:Analysis of Variance; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D015430:Weight Gain