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Incisionless Endoscopic Procedures for Unsuccessful Gastric Bypass

The most popular and effective procedure for the treatment of obesity is the Roux-en-Y gastric bypass (RNYGB). The RNYGB is a combination of a restrictive procedure which reduces the size of the stomach and a malabsorptive procedure that bypasses a section of the small intestine (called the jejunum).

Studies show the following rates of excess weight loss after RNYGB:

  • 67% of excess weight at 1-2 years post-op
  • 60% at 5 years post-op
  • More than 50% at years 5 through 10 post-op
  • RNYBG will fail in some 20-35% of patients for a variety of reasons that are likely multifactorial

The lack of response to gastric bypass anti-obesity surgery is often referred to as post-gastric bypass recidivism.

Weight regain after Gastric Bypass may very well be related to dietary habits. However, many clinicians and studies, including those conducted and published by Dr. Starpoli, have shown that the stomach pouch and/or outlet made smaller by Gastric Bypass surgery can gradually stretch, making the patient lose the sense of fullness and start to eat more. As a result, patients may regain weight.

Read Dr. Starpoli’s published work on the success of stomal revision with TORe

It has also been shown that open, surgical revision of stomach pouch and/or outlet is undesirable because of the inherent surgical risks and the possibility of anastomotic leakage. This observation has lead to incisionless, endoscopic or endolumenal approaches to reduce the diameter and restore it to its former post-operative size.

Dr. Starpoli offers qualified patients a safe and effective incisionless, endoscopic suturing procedure to reduce the size of an enlarged outlet to the original post-bypass proportions. This procedure is performed using a small flexible endoscope and specialized devices that allows sutures to be placed through the endoscope. The scope and suturing devices are inserted through the mouth into the stomach pouch the same way as a standard endoscope. Sutures are then placed around the outlet to reduce the diameter, typically from the size of a silver dollar to less than the size of a dime. The same technique may then be used to place additional sutures in the stomach pouch to reduce its volume capacity.

Dilated GJ anastomosisESG Endoscopic Suturing for gastric bypass revisionPost endoscopic gastric bypass revision

 
“In the evolution of natural orifice, translumenal endoscopic surgery (NOTES), transoral (through the mouth and without incisions) suturing techniques for stomal revision of the dilated GJ anastomosis are examples of the growing capabilities of the gastrointestinal endoscopist performing endosurgery. There may be a chance that your poor weight control after gastric bypass surgery may be the result of an expansion or stretching of the connection between the stomach pouch and the intestine. A simple upper endoscopy can make this diagnosis and you could be offered an incisionless, surgical approach to correct the problem. Of course, sound nutritional advice should be available, as well as close follow up with your medical or bariatric physician.” Dr. Starpoli
 

It is anticipated that patients will feel little to no discomfort from the endoscopic procedure.  Minor side effects may include gas pain, nausea, sore throat, swollen tongue, and lip pain from the insertion of the endoscope into the mouth.

Patients typically return to their normal routine within 48 hours. Following endoscopic outlet and pouch repair, patients should follow the same diet and exercise regimen they did after their initial weight loss surgery.

It depends upon the patient’s insurance plan. If not, self pay options are available. For further information, please speak with Dr. Starpoli at your next appointment.