TY - JOUR
T1 - Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass
T2 - a large multicenter international experience and meta-analysis
AU - Vargas, Eric J.
AU - Bazerbachi, Fateh
AU - Rizk, Monika
AU - Rustagi, Tarun
AU - Acosta, Andres
AU - Wilson, Erik B.
AU - Wilson, Todd
AU - Neto, Manoel Galvao
AU - Zundel, Natan
AU - Mundi, Manpreet S.
AU - Collazo-Clavell, Maria L.
AU - Meera, Shah
AU - Abu-Lebdeh, H. S.
AU - Lorentz, Paul A.
AU - Grothe, Karen B.
AU - Clark, Matthew M.
AU - Kellogg, Todd A.
AU - McKenzie, Travis J.
AU - Kendrick, Michael L.
AU - Topazian, Mark D.
AU - Gostout, Christopher J.
AU - Abu Dayyeh, Barham K.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background and aims: Many patients who undergo bariatric surgery will experience weight regain and effective strategies are needed to help these patients. A dilated gastrojejunal anastomosis (GJA) has been associated with weight recidivism after Roux-en-Y gastric bypass surgery (RYGB). Endoscopic transoral outlet reduction (TORe) with a full thickness endoscopic suturing device (Overstitch, Apollo Endosurgery, Austin, TX) is a minimally invasive therapeutic option. The primary aim of this project was to examine the safety and long-term efficacy data from three bariatric surgery centers and to conduct a systematic review and meta-analysis of the existing literature. Methods: Patients who underwent TORe with the Overstitch device from Jan 2013 to Nov 2016 at 3 participating bariatric surgery centers were included in the multicenter analysis. For the systematic review and meta-analysis, a comprehensive search of multiple English databases was conducted. Random effects model was used. Results: 130 consecutive patients across three centers underwent TORe with an endolumenal suturing device. These patients (mean age 47; mean BMI 36.8) had experienced 24.6% weight regain from nadir weight after RYGB. Average weight lost at 6, 12, and 18 months after TORe was 9.31 ± 6.7 kg (N = 84), 7.75 ± 8.4 kg (N = 70), 8 ± 8.8 kg (N = 46) (p < 0.01 for all three time points), respectively. The meta-analysis included 330 patients. The pooled weight lost at 12 months was 8.4 kg (95% CI 6.5–10.3) with no significant heterogeneity across included studies (p = 0.07). Overall, 14% of patients experienced nausea, 18% had pain and 8% required a repeat EGD. No serious adverse events reported. Conclusion: When implemented as part of a multidisciplinary intervention, TORe using endolumenal suturing is safe, reproducible, and effective approach to manage weight recidivism after RYGB and should be utilized early in the management algorithm of these patients.
AB - Background and aims: Many patients who undergo bariatric surgery will experience weight regain and effective strategies are needed to help these patients. A dilated gastrojejunal anastomosis (GJA) has been associated with weight recidivism after Roux-en-Y gastric bypass surgery (RYGB). Endoscopic transoral outlet reduction (TORe) with a full thickness endoscopic suturing device (Overstitch, Apollo Endosurgery, Austin, TX) is a minimally invasive therapeutic option. The primary aim of this project was to examine the safety and long-term efficacy data from three bariatric surgery centers and to conduct a systematic review and meta-analysis of the existing literature. Methods: Patients who underwent TORe with the Overstitch device from Jan 2013 to Nov 2016 at 3 participating bariatric surgery centers were included in the multicenter analysis. For the systematic review and meta-analysis, a comprehensive search of multiple English databases was conducted. Random effects model was used. Results: 130 consecutive patients across three centers underwent TORe with an endolumenal suturing device. These patients (mean age 47; mean BMI 36.8) had experienced 24.6% weight regain from nadir weight after RYGB. Average weight lost at 6, 12, and 18 months after TORe was 9.31 ± 6.7 kg (N = 84), 7.75 ± 8.4 kg (N = 70), 8 ± 8.8 kg (N = 46) (p < 0.01 for all three time points), respectively. The meta-analysis included 330 patients. The pooled weight lost at 12 months was 8.4 kg (95% CI 6.5–10.3) with no significant heterogeneity across included studies (p = 0.07). Overall, 14% of patients experienced nausea, 18% had pain and 8% required a repeat EGD. No serious adverse events reported. Conclusion: When implemented as part of a multidisciplinary intervention, TORe using endolumenal suturing is safe, reproducible, and effective approach to manage weight recidivism after RYGB and should be utilized early in the management algorithm of these patients.
KW - Bariatric surgery
KW - Endoscopic
KW - Revision
UR - https://www.scopus.com/pages/publications/85021775904
UR - https://www.scopus.com/pages/publications/85021775904#tab=citedBy
U2 - 10.1007/s00464-017-5671-1
DO - 10.1007/s00464-017-5671-1
M3 - Article
C2 - 28664438
AN - SCOPUS:85021775904
SN - 0930-2794
VL - 32
SP - 252
EP - 259
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 1
ER -