Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome
Background Dumping syndrome (DS) is a common complication of bariatric surgery. Treatments include dietary and behavioral changes, as well as pharmacotherapy and revision surgery. All can be costly or hard to adhere to. In recent years, evidence accumulates in favor of endoscopic trans-oral outlet r...
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| Veröffentlicht in: | Surgical endoscopy 2021-12, Vol.35 (12), p.6846-6852 |
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| description | Background
Dumping syndrome (DS) is a common complication of bariatric surgery. Treatments include dietary and behavioral changes, as well as pharmacotherapy and revision surgery. All can be costly or hard to adhere to. In recent years, evidence accumulates in favor of endoscopic trans-oral outlet reduction (TORe) as an effective treatment for DS, targeting the pathophysiology of rapid gastric clearance. The objective of this study is to assess the safety and efficacy of TORe for DS in a single referral center.
Methods
Patients after bariatric surgery suffering DS were followed, and data were retrospectively analyzed. Diagnosis and post-procedural assessment of DS were made clinically using Sigstad score. During the procedure, the anastomotic rim was cauterized. Afterwards, 2 non-interrupted “8-figure” sutures were placed, resulting in imbrication of additional gastric tissue on top of the anastomosis and narrowing to |
| doi_str_mv | 10.1007/s00464-020-08190-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2475397789</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2598297303</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-fd2d14653b5924b99ebe27681258509fe8483d7e5b23fd1f369315d80b985fc23</originalsourceid><addsrcrecordid>eNp9kT9PHDEQxa0oKFyAL5AispQmjcH2rM92GSFCkJDShNryrsdo0a59sXeR7tvHcASkFKmmmN978-cR8knwc8G5vqicd9uOcckZN8JyBu_IRnQgmZTCvCcbboEzqW13TD7W-sAbb4X6QI4BwBplYEPGqxRyHfJuHOhSfKosFz_RvC4TLrRgWIdlzIn6uGChvS-jX0pj61rusezpWGn1EalPgWKM2OhHpDEXGtZ5N6Z7WvcplDzjKTmKfqp49lJPyN33q1-XP9jtz-uby2-3bACtFhaDDKLbKuiVlV1vLfYo9dYIqYziNqLpDASNqpcQg4iwtSBUMLxvF8VBwgn5evDdlfx7xbq4eawDTpNPmNfqZKcVWK2NbeiXf9CHvJbUtnNSWSOtBg6NkgdqKLnWgtHtyjj7sneCu6cg3CEI14Jwz0G4J9HnF-u1nzG8Sv5-vgFwAGprpfbLt9n_sf0DIwmTqw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2598297303</pqid></control><display><type>article</type><title>Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Relly, Reicher ; Mati, Shnell ; Aviv, Cohen Nathaniel ; Fishman, Sigal</creator><creatorcontrib>Relly, Reicher ; Mati, Shnell ; Aviv, Cohen Nathaniel ; Fishman, Sigal</creatorcontrib><description>Background
Dumping syndrome (DS) is a common complication of bariatric surgery. Treatments include dietary and behavioral changes, as well as pharmacotherapy and revision surgery. All can be costly or hard to adhere to. In recent years, evidence accumulates in favor of endoscopic trans-oral outlet reduction (TORe) as an effective treatment for DS, targeting the pathophysiology of rapid gastric clearance. The objective of this study is to assess the safety and efficacy of TORe for DS in a single referral center.
Methods
Patients after bariatric surgery suffering DS were followed, and data were retrospectively analyzed. Diagnosis and post-procedural assessment of DS were made clinically using Sigstad score. During the procedure, the anastomotic rim was cauterized. Afterwards, 2 non-interrupted “8-figure” sutures were placed, resulting in imbrication of additional gastric tissue on top of the anastomosis and narrowing to <1 cm at the end of the procedure. Patients were instructed to keep a liquid diet for 14 days and follow-up continued for 6 months.
Results
Between 8/2018 and 9/2019 TORe was carried out in 13 patients (M:F = 3:10) with mean age of 45.1 (range 25–56) and BMI of 33.5 (range 28.1–40.3). Average time since recent surgery was 5.5 years (range 1–9). Mean pre-procedure anastomosis diameter was 25.2 mm (range 15–30) and was reduced to a mean of 5.6 mm (range 5–10). Three patients (23%) were admitted overnight due to inability to drink which resolved spontaneously. No major complications were reported.
At 6 months, the Sigstad score was significantly reduced (19.4 ± 3.6 vs 5.2 ± 5.5,
P
< 0.001), and 11/13 (85%) of patients had a complete resolution of their dumping symptoms. In addition, BMI decreased by a mean of 2.3 kg/m
2
(−1 to 7.5,
p
= 0.002).
Conclusion
TORe is a safe and effective treatment for patients suffering dumping syndrome and should be considered early in the treatment of DS.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-08190-3</identifier><identifier>PMID: 33398583</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Bariatric Surgery - adverse effects ; Dumping syndrome ; Dumping Syndrome - etiology ; Endoscopy ; Gastric Bypass - adverse effects ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Humans ; Medicine ; Medicine & Public Health ; Middle Aged ; Obesity, Morbid ; Proctology ; Retrospective Studies ; Surgery</subject><ispartof>Surgical endoscopy, 2021-12, Vol.35 (12), p.6846-6852</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2021</rights><rights>2021. Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-fd2d14653b5924b99ebe27681258509fe8483d7e5b23fd1f369315d80b985fc23</citedby><cites>FETCH-LOGICAL-c375t-fd2d14653b5924b99ebe27681258509fe8483d7e5b23fd1f369315d80b985fc23</cites><orcidid>0000-0002-4411-2501</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-08190-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-08190-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33398583$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Relly, Reicher</creatorcontrib><creatorcontrib>Mati, Shnell</creatorcontrib><creatorcontrib>Aviv, Cohen Nathaniel</creatorcontrib><creatorcontrib>Fishman, Sigal</creatorcontrib><title>Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Dumping syndrome (DS) is a common complication of bariatric surgery. Treatments include dietary and behavioral changes, as well as pharmacotherapy and revision surgery. All can be costly or hard to adhere to. In recent years, evidence accumulates in favor of endoscopic trans-oral outlet reduction (TORe) as an effective treatment for DS, targeting the pathophysiology of rapid gastric clearance. The objective of this study is to assess the safety and efficacy of TORe for DS in a single referral center.
Methods
Patients after bariatric surgery suffering DS were followed, and data were retrospectively analyzed. Diagnosis and post-procedural assessment of DS were made clinically using Sigstad score. During the procedure, the anastomotic rim was cauterized. Afterwards, 2 non-interrupted “8-figure” sutures were placed, resulting in imbrication of additional gastric tissue on top of the anastomosis and narrowing to <1 cm at the end of the procedure. Patients were instructed to keep a liquid diet for 14 days and follow-up continued for 6 months.
Results
Between 8/2018 and 9/2019 TORe was carried out in 13 patients (M:F = 3:10) with mean age of 45.1 (range 25–56) and BMI of 33.5 (range 28.1–40.3). Average time since recent surgery was 5.5 years (range 1–9). Mean pre-procedure anastomosis diameter was 25.2 mm (range 15–30) and was reduced to a mean of 5.6 mm (range 5–10). Three patients (23%) were admitted overnight due to inability to drink which resolved spontaneously. No major complications were reported.
At 6 months, the Sigstad score was significantly reduced (19.4 ± 3.6 vs 5.2 ± 5.5,
P
< 0.001), and 11/13 (85%) of patients had a complete resolution of their dumping symptoms. In addition, BMI decreased by a mean of 2.3 kg/m
2
(−1 to 7.5,
p
= 0.002).
Conclusion
TORe is a safe and effective treatment for patients suffering dumping syndrome and should be considered early in the treatment of DS.</description><subject>Abdominal Surgery</subject><subject>Bariatric Surgery - adverse effects</subject><subject>Dumping syndrome</subject><subject>Dumping Syndrome - etiology</subject><subject>Endoscopy</subject><subject>Gastric Bypass - adverse effects</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Obesity, Morbid</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kT9PHDEQxa0oKFyAL5AispQmjcH2rM92GSFCkJDShNryrsdo0a59sXeR7tvHcASkFKmmmN978-cR8knwc8G5vqicd9uOcckZN8JyBu_IRnQgmZTCvCcbboEzqW13TD7W-sAbb4X6QI4BwBplYEPGqxRyHfJuHOhSfKosFz_RvC4TLrRgWIdlzIn6uGChvS-jX0pj61rusezpWGn1EalPgWKM2OhHpDEXGtZ5N6Z7WvcplDzjKTmKfqp49lJPyN33q1-XP9jtz-uby2-3bACtFhaDDKLbKuiVlV1vLfYo9dYIqYziNqLpDASNqpcQg4iwtSBUMLxvF8VBwgn5evDdlfx7xbq4eawDTpNPmNfqZKcVWK2NbeiXf9CHvJbUtnNSWSOtBg6NkgdqKLnWgtHtyjj7sneCu6cg3CEI14Jwz0G4J9HnF-u1nzG8Sv5-vgFwAGprpfbLt9n_sf0DIwmTqw</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Relly, Reicher</creator><creator>Mati, Shnell</creator><creator>Aviv, Cohen Nathaniel</creator><creator>Fishman, Sigal</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4411-2501</orcidid></search><sort><creationdate>20211201</creationdate><title>Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome</title><author>Relly, Reicher ; Mati, Shnell ; Aviv, Cohen Nathaniel ; Fishman, Sigal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-fd2d14653b5924b99ebe27681258509fe8483d7e5b23fd1f369315d80b985fc23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Bariatric Surgery - adverse effects</topic><topic>Dumping syndrome</topic><topic>Dumping Syndrome - etiology</topic><topic>Endoscopy</topic><topic>Gastric Bypass - adverse effects</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Obesity, Morbid</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Relly, Reicher</creatorcontrib><creatorcontrib>Mati, Shnell</creatorcontrib><creatorcontrib>Aviv, Cohen Nathaniel</creatorcontrib><creatorcontrib>Fishman, Sigal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Relly, Reicher</au><au>Mati, Shnell</au><au>Aviv, Cohen Nathaniel</au><au>Fishman, Sigal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>35</volume><issue>12</issue><spage>6846</spage><epage>6852</epage><pages>6846-6852</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Dumping syndrome (DS) is a common complication of bariatric surgery. Treatments include dietary and behavioral changes, as well as pharmacotherapy and revision surgery. All can be costly or hard to adhere to. In recent years, evidence accumulates in favor of endoscopic trans-oral outlet reduction (TORe) as an effective treatment for DS, targeting the pathophysiology of rapid gastric clearance. The objective of this study is to assess the safety and efficacy of TORe for DS in a single referral center.
Methods
Patients after bariatric surgery suffering DS were followed, and data were retrospectively analyzed. Diagnosis and post-procedural assessment of DS were made clinically using Sigstad score. During the procedure, the anastomotic rim was cauterized. Afterwards, 2 non-interrupted “8-figure” sutures were placed, resulting in imbrication of additional gastric tissue on top of the anastomosis and narrowing to <1 cm at the end of the procedure. Patients were instructed to keep a liquid diet for 14 days and follow-up continued for 6 months.
Results
Between 8/2018 and 9/2019 TORe was carried out in 13 patients (M:F = 3:10) with mean age of 45.1 (range 25–56) and BMI of 33.5 (range 28.1–40.3). Average time since recent surgery was 5.5 years (range 1–9). Mean pre-procedure anastomosis diameter was 25.2 mm (range 15–30) and was reduced to a mean of 5.6 mm (range 5–10). Three patients (23%) were admitted overnight due to inability to drink which resolved spontaneously. No major complications were reported.
At 6 months, the Sigstad score was significantly reduced (19.4 ± 3.6 vs 5.2 ± 5.5,
P
< 0.001), and 11/13 (85%) of patients had a complete resolution of their dumping symptoms. In addition, BMI decreased by a mean of 2.3 kg/m
2
(−1 to 7.5,
p
= 0.002).
Conclusion
TORe is a safe and effective treatment for patients suffering dumping syndrome and should be considered early in the treatment of DS.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>33398583</pmid><doi>10.1007/s00464-020-08190-3</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-4411-2501</orcidid></addata></record> |
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| subjects | Abdominal Surgery Bariatric Surgery - adverse effects Dumping syndrome Dumping Syndrome - etiology Endoscopy Gastric Bypass - adverse effects Gastroenterology Gastrointestinal surgery Gynecology Hepatology Humans Medicine Medicine & Public Health Middle Aged Obesity, Morbid Proctology Retrospective Studies Surgery |
| title | Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome |
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