Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients

BACKGROUND: Endoscopic intraluminal suturing is currently used to treat gastroesophageal reflux disease. This new field of intraluminal gastric surgery may benefit postoperative Roux-en-Y gastric bypass patients. While gastric bypass is highly successful in the majority of patients, significant weight regain can occur over time due to stretching of the gastric pouch and stoma. METHODS: Between November 2002 and January 2003, four patients who previously underwent gastric bypass (GBP) surgery presented with dilated gastrojejunostomy (GJ) anastomosis and weight regain. They gave their consent and were taken to the operating room for upper endoscopy, where they were placed under general anesthesia. Using a flexible endoscopic suturing device with a standard 11-mm endoscope, the dilated GJ anastomosis was plicated to reduce its size, and in two of the patients the gastric pouch was also plicated. RESULTS: Successful stomal plication was performed on all four patients to narrow their dilated stomas that measured > 2 cm preoperatively to < 15 mm postoperatively. Patients were told to go on a puree diet for 4 weeks. One patient had a repeat procedure due to rupture of one suture after eating solid food two weeks after the surgery. The stoma was then plicated with 3 sutures. Two patients had their gastric pouch plicated near the stoma. All patients to date report feeling full earlier with decrease caloric consumption and subsequent weight loss. CONCLUSION: Upper endoscopic intraluminal suturing represents a new field of emerging technology that will certainly find its role in the postoperative bariatric patient. Both the gastric pouch and stoma are within reach for endoscopic intraluminal therapy. How it can aid our patients is currently being studied.