Original articlePeroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients
Section snippets
Inclusion criteria
The patients who were referred to our center for evaluation and/or treatment of symptoms thought to be related to intractable dumping syndrome after RYGB were evaluated for possible endoscopic management. All dumping-related symptoms were recorded. Patients then underwent routine screening endoscopy. At endoscopy, the gastric pouch and the area of the gastrojejunostomy were evaluated for signs of post-RYGB complications. In addition, the size of the gastrojejunostomy and the length of the
Results
From July 2005 to July 2007, a total of 20 patients with RYGB presented with dumping symptoms. However, only 6 (30%) had intractable dumping syndrome and presented with a dilated gastrojejunal anastomosis. All patients were women, with a mean age of 45 ± 11 years (range 33–63) and an average preprocedure body mass index (BMI) of 34.5 ± 7.1 (Table 1).
The intractable dumping symptoms reported before the endoscopic procedure are listed in Table 1 and included immediate postprandial nausea and
Discussion
RYGB remains the most common bariatric surgical procedure in the United States, and its effectiveness in inducing significant weight loss has been well-documented [8], [9], [10]. Although dumping syndrome is a common effect after gastric bypass that might help patients adjust their dietary habits and attain their weight loss goals, intractable dumping syndrome that significantly affect their quality of life is relatively rare. A general agreement has been reached that accelerated gastric
Conclusion
According to this initial series, the gastrojejunal aperture appears to have an effect on the symptoms of patients with intractable dumping syndrome. Additionally, endoscopic anastomotic reduction appears to be safe and could offer a minimally invasive treatment option for patients who experience intractable dumping symptoms after RYGB. Additional prospective studies with larger numbers of patients and more substantial follow-up are needed to confirm these early findings.
Disclosures
G. Fernández-Esparrach was supported by a grant from Generalitat de Catalunya (AGAUR, BE-100022). The authors claim no commercial associations that might be a conflict of interest in relation to this article.
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2017, Surgery for Obesity and Related DiseasesCitation Excerpt :One patient underwent a distal pancreatectomy in attempts to treat the condition. Endoscopic trans-oral plication of the gastric pouch or outlet has been described for treatment of intractable post-RYGB dumping but not specifically for treatment or improvement of post-RYGB postprandial hyperinsulinemic hypoglycemia [59,60]. RYGB reversal has been described in a few small series for cases of postprandial hyperinsulinemic hypoglycemia after RYBG resistant to all other treatment modalities.
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2015, Surgery for Obesity and Related DiseasesCitation Excerpt :Although a bilateral truncal vagotomy was also performed in the 2 patients with marginal ulcers to decrease acid output, its benefit in preventing recurrence is controversial [10]. Dumping syndrome is common after RYGB (15%–50% of cases) [25]. Medically refractory symptoms have been managed by surgical or endoscopic reduction of the GJ anastomosis, reconversion to normal anatomy, and even partial pancreatectomy [25,26].
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G. Fernández-Esparrach is currently at Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIPAPS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.