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

Abstract

The study aim is to determine if patients who have undergone endoscopic gastrojejunostomy revision (EGJR) maintain weight loss up to 5years postoperatively. 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. 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 ± 25.2kg and BMI of 42.3 ± 8.5. Weight loss and %EBWL at follow-up was as follows: 10.7 ± 11.6kg and 18.5 ± 18.2% at 6months, 8.5 ± 11.5kg and 14.9 ± 20.6% at 1year, 6.9 ± 10.7kg and 12.2 ± 19.8% at 2years, 5.3 ± 9.1kg and 8.7 ± 14.9% at 3years, 3.1 ± 12.0kg and 3.2 ± 21.6% at 4years, and 3.9 ± 13.1kg and 7.0 ± 23.8% at 5years. 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. Weight loss after EGJR is sustained up to 5years after revision with little effect on medical comorbidities. Patients with a greater reduction in stoma diameter experienced superior weight loss.