Endoscopic submucosal dissection with suturing for the treatment of weight regain after gastric bypass: outcomes and comparison with traditional transoral outlet reduction (with video).

Endoscopic submucosal dissection with suturing for the treatment of weight regain after gastric bypass: outcomes and comparison with traditional transoral outlet reduction (with video).:

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Endoscopic submucosal dissection with suturing for the treatment of weight regain after gastric bypass: outcomes and comparison with traditional transoral outlet reduction (with video).

Gastrointest Endosc. 2020 Jan 30;:

Authors: Jirapinyo P, de Moura DTH, Thompson CC

Abstract

BACKGROUND AND AIMS: Although traditional transoral outlet reduction (TORe) involves argon plasma coagulation (APC) before endoscopic suturing, modified endoscopic submucosal dissection (ESD) has also been used. This study aims to evaluate the safety and efficacy of modified ESD-TORe in comparison with traditional APC-TORe.

METHODS: This was a retrospective study of prospectively collected data of patients who underwent modified ESD-TORe and APC-TORe for weight regain after Roux-en-Y gastric bypass (RYGB). Our outcomes were (1) technical success, adverse events as categorized by the ASGE lexicon, and percent total weight loss (TWL) at 6 and 12 months, and (2) patients who underwent ESD-TORe were matched 1:3 based on gastrojejunal anastomosis (GJA) and pouch sizes to those who underwent APC-TORe. TWLs were compared. A linear regression was performed to control for any confounders.

RESULTS: Nineteen RYGB patients underwent ESD-TORe. Technical success rate was 100%. There were no severe adverse events. At 6 and 12 months, patients experienced 13.4±6.6 % and 12.1±9.3% TWL, respectively (p<0.05 for both). Nineteen ESD-TORe patients were also matched to 57 APC-TORe patients based on GJA and pouch sizes. At 12 months, the ESD-TORe group experienced greater weight loss compared with the APC-TORe group (12.1±9.3% TWL versus 7.5±3.3 TWL (p=0.036)). On regression analysis, ESD remained a significant predictor of %TWL at 12 months after controlling for age, sex, BMI, weight regain and years from RYGB (β=5.99, p=0.02).

CONCLUSION: Combining endoscopic tissue dissection with suturing providers greater and more durable weight loss for patients with weight regain after RYGB.

PMID: 32007520 [PubMed - as supplied by publisher]