Introduction:
Dilatation of the gastrojejunal anastomosis(GJA) is a significant risk factor for weight regain after Roux-en-Y gastric bypass(RYGB). We described the first Australian series of endoscopic suturing using the Overstitch device to correct GJA dilatation in 2016, which has reduced peri-procedural risk compared with revisional bariatric surgery. Advanced suturing techniques enable better GJA plication and could enhance outcomes.
Method:
Patients selected for endoscopic suturing had weight regain of ≥10% after RYGB and GJA stoma dilatation of ≥16mm on endoscopy. The procedure was performed under general anaesthesia. All patients stayed 1 night in hospital. Outcomes measured include complications, BMI and excess weight loss(EWL) achieved. Statistics are reported as a mean ± standard deviation.
Results:
30 patients underwent endoscopic suturing over 18 months(age 50±7.4 years, 28 female), using a variety of suture techniques for GJA plication. BMI prior to RYGB was 45±9 kg/m². Post operative nadir BMI was 31±6.4 kg/m². BMI at the time of endoscopic intervention was 37±6.3 kg/m². Time interval between RYGB and endoscopic intervention was 47.3±22 months. GJA aperture was 19.4±3.5mm. Procedure time was 74±13 minutes. Stoma size after suturing was 8±2.1mm with 2.1±0.8 sutures used. Dislodgement of sutures occurred in 11 patients where a simple interrupted suture pattern was used, associated with loss of satiety and a plateau in weight loss; all undergoing a second endoscopy for repeat suturing (median time interval 6 months).
Mean BMI change and EWL after Overstitch was 2.7±1.8 kg/m² and 26.8±20.8% respectively. Patients who underwent a single procedure had a greater BMI change and EWL compared with patients who underwent redo suturing (2.8±1.3 kg/m² and 32±22.6% vs. 1±1.4 kg/m² and 24.6±10.92%). No complications were reported.
Conclusion:
Endoscopic revision of the GJA is safe and associated with a positive trend in EWL. More durable GJA plication with advanced suturing techniques could yield better outcomes.