title: Gastrojejunal anastomotic reduction for weight regain in roux-en-y gastric bypass patients: physiological, behavioral, and anatomical effects of endoscopic suturing and sclerotherapy.
abstract: BACKGROUND
  Weight regain is common after Roux-en-Y gastric bypass.
  
  
  OBJECTIVE
  To assess the mechanisms of weight loss after 2 gastrojejunal anastomotic reduction (GJAR) procedures to treat weight regain.
  
  
  METHODS
  University hospital, United States.
  
  
  METHODS
  Forty-three Roux-en-Y gastric bypass patients with weight regain were prospectively enrolled. Weight, ghrelin levels, responses to the 21-item three-factor eating questionnaire, and gastrojejunal anastomotic diameter were assessed. Nine patients underwent endoscopic suturing and 34 patients underwent sclerotherapy. At 3 months, weight, ghrelin levels, eating behavior, and outlet diameter were reassessed.
  
  
  RESULTS
  Patients were aged 47±10 years and regained 43%±26% of maximal lost weight. Ghrelin levels were 123±106 ng/mL and outlet diameter was 21±6.3 mm. At 3 months, the entire cohort lost 4.1%±5.9% of total weight (TBW) and showed improvement in cognitive eating habits (P<.01). Endoscopic suturing and sclerotherapy patients lost 10.4%±2.2% TBW and 2.7%±5.5% TBW (P<.01), respectively. Suturing and sclerotherapy reduced the outlet diameter by 15.0±6.7 mm and 2.6±5.7 mm (P<.01). Ghrelin levels increased after suturing by 46±55 ng/mL and decreased by 37±110 ng/mL after sclerotherapy (P = .02). Suturing resulted in greater improvement in cognitive eating behavior than sclerotherapy (P = .03). Reduction in outlet size and changes in cognitive and emotional eating behaviors were predictors of weight loss after GJAR on a univariate analysis. On a multivariate analysis, the only predictor of weight loss was a reduction in outlet size (P< .01).
  
  
  CONCLUSIONS
  Endoscopic suturing resulted in greater reduction in outlet size, improvement in eating behavior, and weight loss than sclerotherapy. Reduction of anastomosis size was a significant predictor of weight loss after GJAR.
authors.affiliation: Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA.
authors.forename: Pichamol
authors.initials: P
authors.lastname: Jirapinyo
authors.affiliation: Harvard Medical School, Boston, MA; Mayo Clinic, Rochester, MN.
authors.forename: Barham K Abu
authors.initials: BK
authors.lastname: Dayyeh
authors.affiliation: Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA. Electronic address: cthompson@hms.harvard.edu.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Thompson
mesh_terms: D003071:Cognition; D004644:Emotions; D005247:Feeding Behavior / Q000502:physiology / Q000523:psychology; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005773:Gastroscopy / Q000379:methods; D054439:Ghrelin / Q000378:metabolism; D000070497:Healthy Lifestyle; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D015911:Sclerotherapy / Q000379:methods*; D013270:Stomach / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss / Q000502:physiology
chemical_list: D054439:Ghrelin
keywords: Endoscopic suturing; Ghrelin; Sclerotherapy; Transoral outlet reduction; Weight regain