Second SLS presentation from Beth Israel

Prospective Evaluation of Endoscopic Plication and Reduction of Gastric Pouch in Patients who Previously Underwent Gastric Bypass Surgery Chiranjiv S Virk MD, Dimitrios V. Avgerinos, MD, Radha Patel, Burton Surick, MD, John L. Holup, DO, Elliot R. Goodman, MD and I. Michael Leitman, MD Department of Surgery Beth Israel Medical Center New York, NY

Commercial Disclosures:
StomaphyX ® is a product of EndoGastric Solutions ®(Redmond, WA).
None of the authors have any financial relationship with EndoGastric Solutions ®.

Results (N=64) 5 (2-10) Median time(years) after Gastric bypass surgery 31.3 Median BMI Post-GB(nadir) 31.3 Median BMI Post-Gastric Bypass (nadir) 48.7 Median BMI Pre-Gastric Bypass 65 Height (inches) 92% female / 8% male Female / Male 47.5 (24-66) A ge (years)

7(12%) No follow up weight available 14(21%) No. Patients no weight loss 43(67%) No. Patients Weight loss 6(1-13) Median follow up(months) 37.75(25.1-55.2) Median BMI post Stomaphyx 39.85 (25.9-54.9) Median BMI before StomaphyX

23(10-40) Median # of fasteners 33%(0-67) Median reduction in gastric pouch length 50 (35-130) Median OR time 15.5(3.3-67) Median weight loss (lbs.) post StomaphyX

RESULTS
Dumping syndrome improved
GERD improved

Endoluminal Gastric Pouch Reduction
3 patients underwent repeat procedure due to unsatisfactory results.
Maximum weight loss: 67 lbs
Postprandial diarrhea/GERD resolved.
Slowed gastric emptying
Obliteration of the gastrocolic reflex
New valve created just distal to GE junction

Endoluminal Gastric Pouch Reduction
Mechanism of Weight loss
Reduce size of gastric pouch
Possible to reduce size of stoma
Reduce compliance in the gastric pouch
Slows gastric emptying

Endoluminal Gastric Pouch Reduction Pre anastomosis Post anastomosis

Endoluminal Gastric Pouch Reduction Gastro-esophageal junction and gastric pouch

Lessons Learned
Reduce anastomotic diameter
Gross pouch dilation difficult to completely remediate
Dumping and GERD symptoms do improve.
Double fastener technique
Weight loss is modest
Procedure is safe.

THANK YOU

Second SLS presentation from Beth Israel

by Beth Israel Medical Center on Nov 14, 2009

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