Original article—alimentary tractGastrojejunal Stoma Diameter Predicts Weight Regain After Roux-en-Y Gastric Bypass
Section snippets
Methods
We reviewed data for all patients referred to our tertiary care bariatric center to undergo upper endoscopy post-RYGB between January 1, 2006, and September 1, 2010. The indication for the upper endoscopy varied and included work-up for epigastric abdominal pain, nausea and vomiting, evaluation of possible gastric fistula and marginal ulcerations, as well as weight regain after RYGB. As a standard practice, all bariatric patients referred to our center for upper endoscopy post-RYGB were
Results
Among the 165 patients included in our study, the average age of the population was 44 years, with 91% females, 68% Caucasians, 16% blacks, 16% Hispanics, 17.5% with a diagnosis of diabetes before the RYGB, 36% on serotonin re-uptake inhibitor therapy, 5% on antipsychotic medications, 20% with known marginal ulcers or erosions, and 50% who underwent an open RYGB procedure. The mean pre-RYGB body mass index for the cohort was 49 (SD, 8). After RYGB, the mean maximal percentage of total body
Conclusions
In this study, we show that an enlarged GJ stoma diameter is a significant risk factor for weight regain after RYGB; thus establishing it as a legitimate delayed postsurgical complication that explains a significant proportion of variability in long-term weight outcomes after RYGB surgery. Stoma dilation thus should be regarded in a manner similar to gastrogastric fistulae or other postsurgical anatomic complications.
This finding is corroborated by earlier observations from vertical banded
Acknowledgments
The authors would like to thank Raymond Chung, MD, and Andrew Chan, MD, MPH, for their critical review of this manuscript.
This study was reviewed and approved by the Partner's Institutional Review Board at the Brigham and Women's Hospital. The Institutional Review Board protocol number is 2003P001597. This study was exempt from written informed consent requirement.
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Conflicts of interest This author discloses the following: Christopher Thompson is a consultant for USGI Medical, BARD Medical, Covidien, Boston Scientific, and ValenTx. The remaining authors disclose no conflicts.
Funding This project was supported in part by a T32 National Institutes of Health training grant to the Massachusetts General Hospital and Barham Abu Dayyeh (T32DK007191).