Sa1970 USE OF THE OVERSTICH DEVICE FOR ENDOSCOPIC REVISION OF ROUX-EN –Y GASTRIC BY-PASS: AN UPDATE FROM THE LARGEST UK SERIES

Abstract

Patients with Roux-en-Y gastric bypass (RYGB) are able to achieve up to 60% weight loss after surgery. However, 30% of these patients will regain weight within 2 years time following the operation. The options for this group of patients are limited. Changes in life style are not effective in most of the cases and re-do another surgery is associated with high risk of complications and lower weight loss. In some of these patients the main issue is the increase of the stoma diameter with time. The Overstitch device is a minimally invasive endoscopic suturing method that can be employed in this setting to facilitate further weight loss. All patients were discussed in a multidisciplinary bariatric meeting having already undergone a diagnostic gastroscopy to assess suitability for the procedure. The endoscopic inclusion criteria were a stoma of at least 2 cm in diameter and a pouch length greater than 3 cm. Forty patients (38 female) with a previous RYGB and weight regain that met the endoscopic criteria were included with a media stoma size of 4 cm. Initially, the mucosa of the outlet was ablated with APC followed by the use of the overstitch device. The suturing pattern chosen was a mixed one with a media of 2 sutures per patient and final stoma media diameter of 2.9 mm (Fig.1 and Fig.2). All the procedure was performed under general anaesthesia with the patient in supine position. After the procedure, the patients followed a strict diet under supervision and preventive symptomatic treatment was prescribed as well. All patients underwent the procedure safely with no major complications. Only two patients presented abdominal pain and nausea which were easily controlled with antiemetic and pain relief medication. Only one underwent the technique twice because of loose sutures. After 1 year of follow-up an average weight loss of 8.9 kg was observed. Endoscopic revision of the RYGB using the Overstitch device is an effective and safe method of achieving further weight loss in patients who have regained weight post-surgery and have a stoma that meets endoscopic criteria. The weight loss effect was sustained at 1 year post-procedure.The longer term benefots need to be determined but it is possible to repeat the procedure in those patients who regain weight .Fig 2RYGB Outlet After Overstich RevisionView Large Image Figure ViewerDownload Hi-res image Download (PPT)