Endoscopic post-bypass revisions

In the care of post Roux-en-Y gastric bypass (RYGB) surgery patients, the late complications of suboptimal weight loss and weight regain are common. Although surgical revision has been the standard of care for these patients, there are now endoscopic technologies and endoluminal procedures available to help gastrointestinal endoscopists obtain similar treatment outcomes with much less associated morbidity. The aim of this article is to review the published literature and endoscopic techniques currently utilized for the endoluminal revision of post-bypass patients. Specifically, we review the use and outcomes of sclerotherapy, endoluminal suturing with the EndoCinch, EndoSurgical Operating System, and StomaphyX systems in the treatment of dilated gastrojejunal stomas and gastric pouches-common causes of RYGB failure. All of these devices have currently proven that endoscopic therapies for patients with complications of weight regain and suboptimal weight loss are feasible and safe, although with variable effectiveness. The potential impact of endoluminal therapies in patients who are poor surgical revision candidates or those who elect for a less invasive endoscopic solution is promising. As the number of postsurgical bariatric patients increases and as these patients mature, the role for endoluminal therapies for patients who develop late complications of suboptimal weight regain or weight loss is expanding.