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Published in:

01-01-2018

Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis

Authors: Eric J. Vargas, Fateh Bazerbachi, Monika Rizk, Tarun Rustagi, Andres Acosta, Erik B. Wilson, Todd Wilson, Manoel Galvao Neto, Natan Zundel, Manpreet S. Mundi, Maria L. Collazo-Clavell, Shah Meera, H. S. Abu-Lebdeh, Paul A. Lorentz, Karen B. Grothe, Matthew M. Clark, Todd A. Kellogg, Travis J. McKenzie, Michael L. Kendrick, Mark D. Topazian, Christopher J. Gostout, Barham K. Abu Dayyeh

Published in: Surgical Endoscopy | Issue 1/2018

Abstract

Background and aims

Many patients who undergo bariatric surgery will experience weight regain and effective strategies are needed to help these patients. A dilated gastrojejunal anastomosis (GJA) has been associated with weight recidivism after Roux-en-Y gastric bypass surgery (RYGB). Endoscopic transoral outlet reduction (TORe) with a full thickness endoscopic suturing device (Overstitch, Apollo Endosurgery, Austin, TX) is a minimally invasive therapeutic option. The primary aim of this project was to examine the safety and long-term efficacy data from three bariatric surgery centers and to conduct a systematic review and meta-analysis of the existing literature.

Methods

Patients who underwent TORe with the Overstitch device from Jan 2013 to Nov 2016 at 3 participating bariatric surgery centers were included in the multicenter analysis. For the systematic review and meta-analysis, a comprehensive search of multiple English databases was conducted. Random effects model was used.

Results

130 consecutive patients across three centers underwent TORe with an endolumenal suturing device. These patients (mean age 47; mean BMI 36.8) had experienced 24.6% weight regain from nadir weight after RYGB. Average weight lost at 6, 12, and 18 months after TORe was 9.31 ± 6.7 kg (N = 84), 7.75 ± 8.4 kg (N = 70), 8 ± 8.8 kg (N = 46) (p < 0.01 for all three time points), respectively. The meta-analysis included 330 patients. The pooled weight lost at 12 months was 8.4 kg (95% CI 6.5–10.3) with no significant heterogeneity across included studies (p = 0.07). Overall, 14% of patients experienced nausea, 18% had pain and 8% required a repeat EGD. No serious adverse events reported.

Conclusion

When implemented as part of a multidisciplinary intervention, TORe using endolumenal suturing is safe, reproducible, and effective approach to manage weight recidivism after RYGB and should be utilized early in the management algorithm of these patients.

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Title: Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis
Authors: Eric J. Vargas
Fateh Bazerbachi
Monika Rizk
Tarun Rustagi
Andres Acosta
Erik B. Wilson
Todd Wilson
Manoel Galvao Neto
Natan Zundel
Manpreet S. Mundi
Maria L. Collazo-Clavell
Shah Meera
H. S. Abu-Lebdeh
Paul A. Lorentz
Karen B. Grothe
Matthew M. Clark
Todd A. Kellogg
Travis J. McKenzie
Michael L. Kendrick
Mark D. Topazian
Christopher J. Gostout
Barham K. Abu Dayyeh
Publication date: 01-01-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 1/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5671-1

At a glance: The STEP trials

Springer Medicine

Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis

Abstract

Background and aims

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusion

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