Original article
Pilot study evaluating technical feasibility and early outcomes of second-generation endosurgical platform for treatment of weight regain after gastric bypass surgery

https://doi.org/10.1016/j.soard.2009.03.217Get rights and content

Abstract

Background

For some gastric bypass patients, dilation of the gastrojejunal anastomosis (GJA) and/or gastric pouch is believed to contribute to weight regain. The present study had 2 objectives: (1) to assess the technical feasibility and safety of a novel endoscopic procedure called “revision obesity surgery endoscopic” (ROSE) using a second-generation, prototype endoscopic operating system that creates tissue plications to reduce the diameter of the GJA and the size of the gastric pouch; and (2) to assess the early outcomes regarding weight loss at a university hospital in the United States.

Methods

This was a prospective study of 5 patients who had regained a mean of 14.7 kg after gastric bypass with a dilated pouch and GJA on screening endoscopy. The gastric pouch and the GJA were measured before and after the procedure. The patients were followed up for a minimum of 3 months after the procedure. Weight changes were recorded.

Results

Technical success was achieved in all 5 patients (100%). The mean weight loss in the successful cases was 7.8 kg at 3 months. No major complications developed.

Conclusion

The results of our study have shown that the ROSE procedure using this second-generation prototype endoscopic operating system is technically feasible and appears safe. Our preliminary results suggest that the ROSE procedure is effective in reducing the size of both the GJA and the gastric pouch and could therefore be an alternative therapy for weight regain in postgastric bypass patients.

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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