Endoscopic full-thickness transoral outlet reduction with semicircumferential endoscopic submucosal dissection

Area of Science:

• Bariatric surgery outcomes
• Minimally invasive endoscopic procedures
• Gastrointestinal anastomosis management

Background:

• Roux-en-Y gastric bypass (RYGB) can lead to gastrojejunal anastomosis (GJA) dilation.
• Endoscopic full-thickness transoral outlet reduction (efTOR) is used to treat GJA dilation.
• Argon plasma coagulation (APC) is a common method for efTOR, but suture rupture can cause recurrent dilation.

Purpose of the Study:

• To introduce and evaluate semicircumferential endoscopic submucosal dissection (ESD-efTOR) as an alternative to APC-efTOR.
• To compare the efficacy of ESD-efTOR and APC-efTOR in reducing GJA diameter and suture rupture.
• To assess technical success, complications, and weight loss outcomes for both procedures.

Main Methods:

• A comparative study involving 41 patients undergoing efTOR for GJA dilation.
• Patients were divided into two groups: APC-efTOR (n=26) and ESD-efTOR (n=15).
• Outcomes assessed included GJA diameter reduction, suture rupture rates, technical success, complications, and weight loss at 3 and 12 months.

Main Results:

• ESD-efTOR showed significantly lower suture rupture rates (20% vs. 69%) compared to APC-efTOR.
• ESD-efTOR achieved a greater reduction in GJA diameter (major 20% vs. 0%) than APC-efTOR after 3 months.
• Technical efficacy, procedure time, and complication rates were comparable between the two methods.

Conclusions:

• ESD-efTOR is a superior technique for reducing GJA diameter and minimizing suture rupture after RYGB compared to APC-efTOR.
• ESD-efTOR offers a promising alternative for managing GJA dilation with improved outcomes.
• The study highlights the potential of ESD-efTOR in enhancing the long-term success of bariatric surgery.