title: Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: Techniques and efficacy.
abstract: OBJECTIVE
  To investigate the techniques and efficacy of peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery.
  
  
  METHODS
  An extensive English language literature search was conducted using PubMed, MEDLINE, Medscape and Google to identify peer-reviewed original and review articles using the keywords "bariatric endoscopic suturing", "overstitch bariatric surgery", "endoscopic anastomotic reduction", "bariatric surgery", "gastric bypass", "obesity", "weight loss". We identified articles describing technical feasibility, safety, efficacy, and adverse outcomes of overstitch endoscopic suturing system for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass (RYGB). All studies that contained material applicable to the topic were considered. Retrieved peer-reviewed original and review articles were reviewed by the authors and the data extracted using a standardized collection tool. Data were analyzed using statistical analysis as percentages of the event.
  
  
  RESULTS
  Four original published articles which met our search criteria were pooled. The total number cases were fifty-nine with a mean age of 46.75 years (34-63 years). Eight of the patients included in those studies were males (13.6%) and fifty-one were females (86.4%). The mean time elapsed since the primary bypass surgery was 5.75 years. The average pre-endoscopic procedure body mass index (BMI) was 38.68 (27.5-48.5). Mean body weight regained post-RYGB surgery was 13.4 kg from their post-RYGB nadir. The average pouch length at the initial upper endoscopy was 5.75 cm (2-14 cm). The pre-intervention anastomotic diameter was averaged at 24.85 mm (8-40 mm). Average procedure time was 74 min (50-164 min). Mean post endoscopic intervention anastomotic diameter was 8 mm (3-15 mm). Weight reduction at 3 to 4 mo post revision noted to be an average of 10.1 kg. Average overall post revision BMI was recorded at 37.7. The combined technical and clinical success rate was 94.9% (56/59) among studied participants.
  
  
  CONCLUSIONS
  Endoscopic suturing can be technically feasible, effective and safe for transoral outlet reduction in patients with weight regain following RYGB.
authors.affiliation: Kinesh Changela, Emmanuel Ofori, Sushil Duddempudi, Sury Anand, Division of Gastroenterology, the Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, NY 11201, United States.
authors.forename: Kinesh
authors.initials: K
authors.lastname: Changela
authors.affiliation: Kinesh Changela, Emmanuel Ofori, Sushil Duddempudi, Sury Anand, Division of Gastroenterology, the Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, NY 11201, United States.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ofori
authors.affiliation: Kinesh Changela, Emmanuel Ofori, Sushil Duddempudi, Sury Anand, Division of Gastroenterology, the Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, NY 11201, United States.
authors.forename: Sushil
authors.initials: S
authors.lastname: Duddempudi
authors.affiliation: Kinesh Changela, Emmanuel Ofori, Sushil Duddempudi, Sury Anand, Division of Gastroenterology, the Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, NY 11201, United States.
authors.forename: Sury
authors.initials: S
authors.lastname: Anand
authors.affiliation: Kinesh Changela, Emmanuel Ofori, Sushil Duddempudi, Sury Anand, Division of Gastroenterology, the Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, NY 11201, United States.
authors.forename: Shashideep
authors.initials: S
authors.lastname: Singhal
keywords: Bariatric surgery; EndoCinch; Endoscopic anastomosis reduction; Endoscopic suturing; Overstitch bariatric surgery