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DUMPING SYNDROME AFTER GASTRIC BYPASS: ENDOLUMINAL REVISION OF THE DILATED GASTROJEJUNOSTOMY IS A SAFE AND HIGHLY EFFECTIVE TREATMENT OPTION
Catherine Tsai^*, Ulf Kessler, Rudolf Steffen, Hans Merki, Joerg Zehetner
Visceral Surgery, Clinic Beau Site, Bern, Switzerland
Background: Dumping syndrome is a known long-term complication of Roux-en-Y gastric bypass. Most often dumping can be avoided with dietary changes. Severe dumping syndrome is characterized by multiple daily episodes with significant impact on quality-of-life. As dumping correlates with rapid pouch emptying through a dilated gastrojejunostomy, the aim of this study was to assess endoluminal revision of the anastomosis regarding feasibility, safety and outcome.

Methods: From January 2016 to October 2017 we reviewed the electronic records of all patients with dumping syndrome undergoing endoluminal revision of the gastrojejunostomy with the Apollo Overstitch system (Apollo Endosurgery, Austin, Texas, USA). Demographic details, procedure details and outcome variables were recorded.

Results: There were 21 patients (M:F=6:15) treated with endoluminal revision for either dumping syndrome (n=13) or dumping syndrome and weight-regain (n=8). The mean procedure time was 19.3 min, with a median number of 1 suture (range 1-3). There were no complications recorded within 30 days (no bleeding, no re-intervention, no dilation). All patients had treatment response, with 66.6% having resolved and 33.3% having improved symptoms. Recurrence of symptoms occurred in 6 (46.1%) of 13 patients treated for dumping only, of them 5 patients required a second Apollo intervention while 1 patient underwent laparoscopic pouch revision with placement of a silastic ring, with treatment response thereafter.

Conclusion: Endoluminal revision of the dilated gastrojejunostomy is a highly effective treatment for dumping syndrome after Roux-en-Y gastric bypass. Due to its endoluminal approach it is a very feasible and safe procedure, and effective for immediate symptom resolution in nearly all patients. In some patients repeat narrowing of the anastomosis is necessary for maintenance of symptom resolution.

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