title: Six month outcomes in patients experiencing weight gain after gastric bypass who underwent gastrojejunal revision using an endoluminal suturing device.
abstract: BACKGROUND
  Weight gain after Roux-en-Y gastric bypass occurs in approximately 25 % of cases, and this may contribute to recurrence of comorbid conditions. Currently, adequate treatment strategies for this group of patients are limited. Endoscopic narrowing of the gastrojejunal anastomosis may result in a low-risk, minimally invasive treatment alternative compared to standard surgical revision. We assessed short-term outcomes in patients undergoing endoscopic gastrojejunal revisions (EGJR) using an endoluminal suturing device.
  
  
  METHODS
  We performed an institutional review board-approved retrospective analysis of 25 consecutive patients who underwent EGJR. Patients preoperatively presented with a dilated gastrojejunal anastomosis of greater than 15 mm and weight gain. An endoluminal suturing device (Overstitch(TM), Apollo Endosurgery, Austin TX) was used to reduce the diameter of the anastomosis. Follow-up occurred at 2 and 6 weeks, 3 and 6 months, and 1 year
  
  
  RESULTS
  Prior to EGJR, patients regained an average of 23.4 ± 13.2 kg from their weight loss nadir and had a mean body mass index of 42.2 ± 6.6 kg/m(2). At 6 weeks, 100 % of patients experienced weight loss (average 5.8 ± 4.4 kg; p < .001). At 3 months, 94 % had weight loss (average 7.0 ± 6.2 kg; p < .001). At 6 months, 91 % maintained weight loss (average 5.6 ± 6.2 kg; p = 0.013). Lastly, at 1 year following EGJR, 100 % of available cases maintained weight loss (average 7.5 ± 6.4 kg; p = 0.057). The average percent excess weight loss was 12.5, 15.4, 12.4, and 17.1 % at 6 weeks, 3 and 6 months, and 1 year, respectively. There was a negative time effect in the mixed effect model using both on-treatment and intent-to-treat analyses, illustrating a significant weight reduction over time. The average follow-up per patient was 146 days. There were no complications reported during the follow-up period.
  
  
  CONCLUSIONS
  Six month follow-up for EGJR patients demonstrated a low-risk, minimally invasive treatment option to reverse weight gain subsequent to a failed gastric bypass. Procedures presented no complications and may provide an attractive alternative to standard surgical revision.
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, 60201, Evanston, IL, USA, mgitelis2@northshore.org.
authors.forename: M
authors.initials: M
authors.lastname: Gitelis
authors.forename: M
authors.initials: M
authors.lastname: Ujiki
authors.forename: L
authors.initials: L
authors.lastname: Farwell
authors.forename: J
authors.initials: J
authors.lastname: Linn
authors.forename: C
authors.initials: C
authors.lastname: Wang
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.forename: C
authors.initials: C
authors.lastname: Sula
authors.forename: J
authors.initials: J
authors.lastname: Carbray
authors.forename: S
authors.initials: S
authors.lastname: Haggerty
authors.forename: W
authors.initials: W
authors.lastname: Denham
mesh_terms: D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007087:Illinois; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D015430:Weight Gain