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transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

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World Journal of Gastrointestinal Endoscopy 2023年第10期15卷 602-613页

作者： Daniel B Maselli Vibhu Chittajallu Chase Wooley Areebah Waseem Daniel Lee Michelle Secic Lauren LDonnangelo Brian Coan Christopher E McGowan Clinical Research True You Weight LossAtlantaGA 30342United States Department of Gastroenterology and Hepatology University Hospitals Cleveland Medical CenterClevelandOH 44106United States Clinical Research True You Weight LossCaryNC 27513United States Secic Statistical Consulting ClevelandOH 44106United States

BACKGROUND transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community *** To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after *** This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September *** were provided longitudinal nutritional support via virtual *** primary outcome was total body weight loss(TBWL)at twelve months from *** outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive *** Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after *** pre-and post-TORe outlet diameter was 35 mm and 8 mm,*** was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve *** was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve *** number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic *** was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

关键词： transoral outlet reduction Purse-string Roux-en-Y gastric bypass Obesity Endoscopic revision Weight recurrence Gastrojejunal anastomosis

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Endoscopic therapy of weight regain after bariatric surgery

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1584-1596页

作者： Milutin Bulajic Salvatore Francesco Vadalà di Prampero Ivo Boškoski Guido Costamagna Department of Gastroenterology and Digestive Endoscopy Mater Olbia HospitalOlbia 07026Italy Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic *** revision of these patients has significant risks and limited *** revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective,safe,less invasive and even reproducible *** herein discuss the indication,selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric *** research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

关键词： Morbid obesity Weight regain Endoscopic sleeve gastroplasty transoral outlet reduction Bariatric surgery Full thickness suturing

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