Five-year results of endoscopic gastrojejunostomy revision (transoral outlet reduction) for weight gain after gastric bypass.

ABSTRACT

BACKGROUND: The study aim is to determine if patients who have undergone endoscopic gastrojejunostomy revision (EGJR) maintain weight loss up to 5 years postoperatively. METHODS: This is a retrospective review of patients who underwent EGJR with a full-thickness endoscopic suturing device between April 2009 and June 2018. Percent of excess body weight loss (%EBWL) was calculated using the weight on day of EGJR consult as baseline. The paired t test and McNemar's test were used to compare weight and comorbidities between preoperative and postoperative time points. RESULTS: A total of 70 patients regained a mean of 42.8 ± 18.7% of the weight lost after gastric bypass. On day of EGJR consult, average was 116.1 ± 25.2 kg and BMI of 42.3 ± 8.5. Weight loss and %EBWL at follow-up was as follows 10.7 ± 11.6 kg and 18.5 ± 18.2% at 6 months, 8.5 ± 11.5 kg and 14.9 ± 20.6% at 1 year, 6.9 ± 10.7 kg and 12.2 ± 19.8% at 2 years, 5.3 ± 9.1 kg and 8.7 ± 14.9% at 3 years, 3.1 ± 12.0 kg and 3.2 ± 21.6% at 4 years, and 3.9 ± 13.1 kg and 7.0 ± 23.8% at 5 years. The percentage of patients with obstructive sleep apnea, hypertension, hyperlipidemia, and diabetes did not change over time. Patients who received a pursestring revision or had a greater percent reduction in stoma diameter had more significant %EBWL. CONCLUSIONS: Weight loss after EGJR is sustained up to 5 years after revision with little effect on medical comorbidities. Patients with a greater reduction in stoma diameter experienced superior weight loss.