Thompson CC et al. (2006) Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight gain. Surg Endosc 20: 1744–1748

Roux-en-Y gastric bypass is a successful treatment for severe obesity, but patients who undergo the procedure can experience subsequent weight regain. Dilation of the gastrojejunal anastomosis has been implicated in this weight gain, but the need for surgical revision must be weighed against the risk of complications associated with this procedure. Thompson et al. assessed the efficacy of an endoscopic suturing procedure to tighten the gastrojejunal opening in eight women with a dilated anastomosis who had experienced weight gain following a previous gastric bypass.

Sutures were placed using the EndoCinch suturing system (CR Bard, Murray Hill, NJ). An average of 2 stitches (range 1–3) was placed during the reduction procedure; the mean anastomosis diameter was reduced from 25 mm to 10 mm. The mean follow-up was 4 months; six of the eight patients lost weight, with the mean weight loss being 10 kg. Four patients experienced a durable improvement in satiety. A transient improvement was reported by three additional patients, who requested a repeat procedure that resulted in further weight loss in two cases. The greatest weight loss (19–20 kg) was experienced by the patients with the most sutures (six stitches over two procedures) and the greatest reduction in anastomosis diameter (75–80% reduction). Adverse effects were nausea, vomiting and sore throat; no serious complications were reported.

The authors conclude that endoscopic anastomosis reduction shows promise as a safe, minimally invasive treatment for patients who experience weight regain after gastric bypass.