Background and Aims

Roux-en-Y gastric bypass (RYGB) is refractory to lifestyle and pharmacotherapy measures, requiring reversal of the patient’s bariatric surgery. Reversal can lead to weight regain and recrudescence of their comorbidities. Our aim was to report a multicenter experience on the endoscopic management of refractory dumping syndrome with endoscopic transoral outlet reduction (TORe).

Methods

A multicenter international series of consecutive patients who underwent TORe with a full-thickness endoscopic suturing device was analyzed for technical success, improvement in Sigstad scores, and weight trajectories after the procedure. Failure was defined as needing an enteral feeding tube, surgical reversal, or repeat TORe.

Results

One hundred fifteen patients across 2 large academic centers in Germany and the United States underwent TORe for dumping syndrome. Patient age was mean 8.9 ± 1.1 years from their initial RYGB with an average percent total body weight loss of 31% ± 10.6% at the time of endoscopy. Three months postprocedure, the Sigstad score improved from a mean of 17 ± 6.1 to 2.6 ± 1.9 (paired t test P = .0001) with only 2% of patients (n = 2) experiencing weight gain. Mean weight loss and percentage of total body weight loss 3 months post-TORe were 9.47 ± 3.6 kg and 9.47% ± 2.5%, respectively. Six patients (5%) failed initial endoscopic therapy, with 50% (n = 3) successfully treated with a repeat TORe. Three patients underwent surgical reversal, indicating an overall 97% endoscopic success rate.

Conclusions

TORe as an adjunct to lifestyle and pharmacologic therapy for refractory dumping syndrome is safe and effective at improving dumping syndrome and reducing rates of surgical revision.

中文翻译：

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Roux-en-Y 胃旁路术后倾倒综合征的内镜治疗：大型国际系列和提出的管理策略。

背景和目标

Roux-en-Y 胃旁路术 (RYGB) 对生活方式和药物治疗措施无效，需要逆转患者的减肥手术。逆转会导致体重反弹和合并症复发。我们的目的是报告内镜下经口缩小术 (TORe) 治疗难治性倾倒综合征的多中心经验。

方法

对使用全层内窥镜缝合装置接受 TORe 的连续多中心国际系列患者进行了技术成功、Sigstad 评分改善和术后体重轨迹的分析。失败被定义为需要肠内营养管、手术逆转或重复 TORe。

结果

德国和美国 2 个大型学术中心的 115 名患者因倾倒综合征接受了 TORe。患者年龄从最初的 RYGB 平均为 8.9 ± 1.1 岁，在内窥镜检查时平均总体体重减轻百分比为 31% ± 10.6%。术后三个月，Sigstad 评分从平均 17 ± 6.1 提高到 2.6 ± 1.9（配对t检验P  = .0001），只有 2% 的患者（n = 2）体重增加。TORe 后 3 个月的平均体重减轻和总体体重减轻百分比分别为 9.47 ± 3.6 kg 和 9.47% ± 2.5%。6 名患者 (5%) 初始内镜治疗失败，50% (n = 3) 成功接受重复 TORe 治疗。三名患者接受了手术逆转，表明总体内镜成功率为 97%。

结论

TORe 作为生活方式和药物治疗难治性倾倒综合征的辅助手段，在改善倾倒综合征和降低手术翻修率方面是安全有效的。