Original articlePilot study evaluating technical feasibility and early outcomes of second-generation endosurgical platform for treatment of weight regain after gastric bypass surgery
Section snippets
Patient selection
Five patients who had weight regain, decreased satiety, and a dilated GJA and gastric pouch were evaluated for the ROSE procedure. All patients underwent preliminary upper endoscopy for measurement of the gastric pouch and GJA and to rule out gastrogastric fistula, marginal ulcers, or varices, which would have excluded the patients from the study. Additionally, patients with significant psychiatric illness, lithium dependency, alcohol dependency, tobacco dependency, or controlled substance
Results
A total of 5 patients (5 women) were included in the present study. The mean patient age was 48 years (range 41–55). The average interval between the gastric bypass and the ROSE procedure was 4 years, 8 months (range 2 years to 6 years, 4 months). The mean maximal postgastric bypass weight loss was 48 kg (range 31–72). Patients had regained a mean of 14.7 kg (range 7.8–25) from their postgastric bypass nadir weight and had a mean BMI of 35.7 kg/m2 at the ROSE procedure (Table 1). At initial
Discussion
RYGB is a largely successful treatment modality for morbid obesity. However, some patients experience weight regain or inadequate weight loss. One study found that 20% of RYGB patients had a BMI >35 kg/m2 at 10 years of follow-up, which is considered treatment failure [9]. Dilation of the pouch or GJA can contribute to weight regain through decreased satiety and greater caloric intake. This observation has led to some surgeons placing silastic rings at the GJA to prevent stretching; these
Conclusion
The ROSE procedure is technically feasible and appears safe. Our preliminary results suggest that the ROSE procedure is effective at reducing, not only the size of the GJA, but also the gastric pouch, and could be an alternative for patients experiencing weight regain or inadequate weight loss after RYGB. Additional study is underway to assess the long-term efficacy in terms of weight loss.
Disclosures
Dr. Thompson serves as a consultant for USGI Medical, San Clemente, California; the other authors have no disclosures.
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