Roux-en-Y gastric bypass for patients with obesity has been the preferred procedure for patients with severe GERD (gastroesophageal reflux disease). However, some patients will still develop severe GERD postoperatively. We present our experience with endoscopic plication of the gastrojejunostomy and gastric pouch as a treatment for postoperative GERD in bypass patients.
A total of 40 patients underwent endoscopic plication of their gastrojejunostomy and pouch for severe GERD from 2017 to 2019 using an endoscopic suturing device by a single surgeon at a single institution. Indications for surgery were verified based upon preoperative visit and operative note documentation
A total of 32 female (80%) and 8 male (20%) patients with a mean age of 48.8 years old underwent endoscopic revision of their gastrojejunostomy and pouch for severe GERD after gastric bypass surgery. The average preoperative BMI (body mass index) was 39.9 kg/m2. Mean follow-up after their procedure was 2.85 months (n=36) with 4 patients lost to follow up. Regarding anti-reflux medication usage, the mean follow up was 3.1 months (n=36), and the average number of reflux medications per patient postoperatively was 0.76. No major complications were reported with this procedure.
As the number of bariatric surgeries continues to increase, the issue of postoperative GERD after gastric bypass will become increasingly common. Endoscopic plication and revision of the gastrojejunostomy and pouch for postoperative GERD is a viable and safe alternative to laparoscopic surgical revision.