Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 25, 2016; 8(4): 239-243
Published online Feb 25, 2016. doi: 10.4253/wjge.v8.i4.239
Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: Techniques and efficacy
Kinesh Changela, Emmanuel Ofori, Sushil Duddempudi, Sury Anand, Shashideep Singhal
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
Shashideep Singhal, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Author contributions: Changela K and Ofori E wrote the paper; Duddempudi S, Anand S and Singhal S supervised the writing of paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at kinooo2002@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kinesh Changela, MD, Division of Gastroenterology, the Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, 121 DeKalb Avenue, Brooklyn, NY 11201, United States. kinooo2002@gmail.com
Telephone: +1-516-5828772
Received: September 8, 2015
Peer-review started: September 17, 2015
First decision: October 13, 2015
Revised: December 16, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: February 25, 2016
Abstract

AIM: 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.

CONCLUSION: Endoscopic suturing can be technically feasible, effective and safe for transoral outlet reduction in patients with weight regain following RYGB.

Keywords: Endoscopic anastomosis reduction, Bariatric surgery, Endoscopic suturing, EndoCinch, Overstitch bariatric surgery

Core tip: Roux-en-Y gastric bypass is one of the most effective bariatric surgical procedures, but is associated with 5% weight regain during 1 to 3 years post procedure. Such weight regain has been attributed to a dilated gastrojejunal anastomosis (GJA). However given the increased perioperative risk of mortality, surgical revision is not generally considered. Endoscopic suturing system has shown potential in reducing the dilated GJA.