Peroral endoscopic reduction of dilated gastrojejunalanastomosis after bariatric surgery： Techniques andefficacy

AIM To investigate the techniques and efficacy ofperoral endoscopic reduction of dilated gastrojejunalanastomosis after bariatric surgery.METHODS： An extensive English language literaturesearch was conducted using PubMed, MEDLINE,Medscape and Google to identify peer-reviewed originaland review articles using the keywords ＂bariatricendoscopic suturing＂, ＂overstitch bariatric surgery＂,＂endoscopic anastomotic reduction＂, ＂bariatric surgery＂,＂gastric bypass＂, ＂obesity＂, ＂weight loss＂. We identifiedarticles describing technical feasibility, safety, efficacy,and adverse outcomes of overstitch endoscopic suturingsystem for transoral outlet reduction in patients withweight regain following Roux-en-Y gastric bypass （RYGB）.All studies that contained material applicable to the topicwere considered. Retrieved peer-reviewed original andreview articles were reviewed by the authors and thedata extracted using a standardized collection tool. Datawere analyzed using statistical analysis as percentages ofthe event.RESULTS： Four original published articles which met oursearch criteria were pooled. The total number cases werefifty-nine with a mean age of 46.75 years （34-63 years）.Eight of the patients included in those studies weremales （13.6%） and fifty-one were females （86.4%）. Themean time elapsed since the primary bypass surgerywas 5.75 years. The average pre-endoscopic procedurebody mass index （BMI） was 38.68 （27.5-48.5）. Meanbody weight regained post-RYGB surgery was 13.4 kgfrom their post-RYGB nadir. The average pouch length atthe initial upper endoscopy was 5.75 cm （2-14 cm）. Thepre-intervention anastomotic diameter was averagedat 24.85 mm （8-40 mm）. Average procedure time was74 min （50-164 min）. Mean post endoscopic interventionanastomotic diameter was 8 mm （3-15 mm）. Weightreduction at 3 to 4 mo post revision noted to be an average of 10.1 kg. Average overall post revision BMIwas recorded at 37.7. The combined technical andclinical success rate was 94.9% （56/59） among studiedparticipants.CONCLUSION： Endoscopic suturing can be technicallyfeasible, effective and safe for transoral outlet reductionin patients with weight regain following RYGB.