title: Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction.
abstract: Approximately 20-30 % of morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGB) will experience significant weight regain in the years following surgery. Endoscopic gastrojejunal revision (EGJR) has been shown to be a safe, effective and less invasive alternative to revisional surgery, with promising weight loss outcomes. However, minimal data exist regarding how to perform the procedure most effectively and what factors may predict good outcomes. We compared weight loss outcomes between patients undergoing endoscopic stoma revision by one of two full-thickness suturing techniques.
  
  
  
  A retrospective review of patients undergoing EGJR between 06/2012 and 09/2015 was performed. Included patients were adults 18-74 years of age who had experienced weight regain ≥2 years after initial RYGB with stoma dilation ≥15 mm in diameter. Revision was done with either an interrupted (IRT) or purse-string (PST) suture technique. A linear mixed effects model was constructed to predict postoperative weight loss.
  
  
  
  Fifty revisions (IRT = 36, PST = 14) were performed in 47 patients (92 % female, mean age of 50.9 ± 10.9 years and body mass index of 41.4 ± 7.1 kg/m2). Technical success (stoma diameter ≤10 mm) was achieved in all cases. Final diameter was significantly smaller in the PST group, 6.6 ± 2.2 mm versus 4.8 ± 1.8 mm (p < 0.01), resulting in a significantly greater % stoma reduction (76.8 ± 8.5 % vs. 84.2 ± 5.1 %, p < 0.01) versus the IRT group. PST resulted in greater % excess weight loss over time compared to IRT. Sixteen comorbid conditions resolved among 12 patients. No major complications occurred.
  
  
  
  Endoscopic revision of the gastric outlet results in meaningful weight loss and comorbidity resolution in select patients experiencing weight regain following RYGB. A PST revision likely results in higher and more sustainable weight loss when compared to IRT.
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Lava Y
authors.initials: LY
authors.lastname: Patel
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Brown
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stringer
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Gitelis
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Linn
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Woody E
authors.initials: WE
authors.lastname: Denham
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Farwell
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Haggerty
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA. mujiki@northshore.org.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ujiki
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004108:Dilatation, Pathologic; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D054047:Surgical Stomas; D013536:Suture Techniques; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss
keywords: Endoluminal therapy; Gastric pouch and stoma dilation; Revisional bariatric surgery; Weight regain