Endoscopic Gastrojejunal (GJ) outlet revision

Roux-en-y gastric bypass (RYGB) is the most popular surgical procedure currently offered to obese patients. In this procedure, the stomach is cut into two parts. The upper part becomes the working stomach, and it can only hold about 1 ounce at a time of the procedure. A cut is made in the section of the intestine called the jejunum, and this part of the intestine is connected to the new pouch. The Roux-en-y gastric bypass is considered the combination restrictive and malabsorptive procedure, which is why it is so successful at achieving weight loss.

However, patients who have undergone RYGB may notice that two to three years after their procedure they begin to regain the weight they lost. This maybe be due to a number of factors, but one reason may be due to the stretching and dilation of the surgical connections made during the initial procedure. Over time the surgical connection made between the gastric pouch and the intestine (jejunum), also known as the gastrojejunal (GJ) outlet, can stretch wider and wider. This allows patients to eat more quantities of food then they were able to just after their procedure, loosing the restrictive benefits of the procedure. To correct this, the GJ outlet is tightened back down so patients regain a sense of early fullness with eating. Revising and tightening the GJ outlet surgically can be challenging and associated with complications.

However, now there are endoscopic options to tighten the GJ outlet without an actual surgery. During this procedure, and endoscope is inserted through the mouth to the level of the GJ outlet. Specialized tools allow for endoscopic sutures to be place to tighten the GJ outlet to the level it was just after the original procedure. Patients are completely asleep for this procedure, which takes only 45 minutes and done on an outpatient basis. Studies have shown that patients can lose and average 20 to 25 pounds if they make dietary, lifestyle, and exercise changes after the procedure. This has been shown to be most effective in patients who carry a BMI greater than 40kg/m2 and are attempt to lose another 20 to 30 pounds.