Sa1945 TRANSORAL OUTLET REDUCTION FOR THE TREATMENT OF DUMPING SYNDROME IN PATIENT WITH ROUX-EN-Y GASTRIC BYPASS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Dumping syndrome is a well-known complication of roux-en-Y gastric bypass (RYGB) and is characterized by episodes of post-prandial hypoglycemia and symptoms of diarrhea, flushing and abdominal pain. While patients with mild dumping symptoms can be managed with lifestyle modifications and medications, Transoral outlet reduction (TORe) may be effective for more severe symptoms. The primary aim of this study was to perform a structured systematic review and meta-analysis to evaluate the effectiveness of TORe in the treatment of dumping syndrome after RYGB Individualized search strategies were developed for PubMed, EMBASE, Web of Science, and Cochrane Library databases from inception through November 2019 in accordance with PRISMA and MOOSE guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included pooled technical success, clinical success (including pre- and post-Sigstad scores, when available), intra- and post-operative adverse events, and rate of re-intervention. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot using Egger and Begg tests. A total of 8 studies (n= 281 patients; 78.61% male) were included in this meta-analysis. One prospective and 7 retrospective studies were included. Mean age of patients was 45.55 ±2.16 years. Average weight for included patients was 93.912 ±5.56 kg with a BMI of 38.97 ±5.28 kg/m2 and pre-procedure gastrojejunal anastomosis size of 22.26 ±0.33 mm. Pooled technical and clinical success of TORe was 98.06% and 89.56%, respectively - Table. Among studies reporting Sigstad scores, TORe resulted in a significant improvement post-procedure [mean Sigstad score difference of -12.44 (95% CI, -13.31 to -11.57); P<0.001]. Mean procedure time was 33.99 ±15.45 min with an intra-operative adverse event rate of 3.13%. Over a mean follow-up of 7.86 ±6.58 months, post-procedure associated adverse events occurred in 3.98% of patients with a re-intervention rate of 14.77%. Of those requiring re-intervention, 73% were successfully managed endoscopically without the need for surgical revision. Based upon the results of this systematic review and meta-analysis, TORe appears to be an effective and safe modality for the treatment of dumping syndrome. The procedure is associated with high clinical success rates and low risks for adverse events. Future studies are needed to compare endoscopic revision to other standard treatments.