Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology - University of Leipzig Medical Center, Leipzig, Germany.
IFB Adiposity Diseases, University of Leipzig Medical Center, Leipzig, Germany.
Endoscopy. 2019 Jul;51(7):684-688. doi: 10.1055/a-0866-9427. Epub 2019 Apr 15.
Endoscopic full-thickness transoral outlet reduction (efTOR) is a therapeutic option to reduce a dilated gastrojejunal anastomosis (GJA) after Roux-en-Y gastric bypass (RYGB). Mucosal ablation with argon plasma coagulation (APC) is usually performed to achieve tissue adaptation. However, rupture of sutures before scarring can lead to recurrent dilatation of the GJA. Here, we describe efTOR with a semicircumferential endoscopic submucosal dissection (ESD-efTOR) as an alternative to APC-efTOR.
We enrolled 41 patients with comparable baseline characteristics (APC-efTOR 26; ESD-efTOR 15). The main objectives were reduction in the GJA diameter and in ruptured sutures. Technical success, complications, total weight loss (TWL), and percentage of total and excess weight loss (%TWL and %EWL) at 3 and 12 months, were assessed.
ESD-efTOR resulted in significantly fewer ruptured sutures (20 % vs. 69 %; = 0.004) and a greater reduction in the GJA (major 20 % vs. 0 %; minor 54 % vs. 37 %; no reduction 13 % vs. 58 %; = 0.02) after 3 months. Technical efficacy, examination time, and rate of complications were comparable.
ESD-efTOR resulted in a significantly greater reduction in the GJA diameter and a lower risk of ruptured sutures compared with APC-efTOR.
经口内镜全层切除术（efTOR）是治疗 Roux-en-Y 胃旁路（RYGB）后扩张胃空肠吻合口（GJA）的一种治疗选择。通常采用氩等离子凝固（APC）进行黏膜消融以实现组织适应。然而，在瘢痕形成之前缝线破裂可导致 GJA 再次扩张。在此，我们描述了一种替代 APC-efTOR 的半环型内镜黏膜下剥离术（ESD-efTOR）。
我们纳入了 41 例基线特征相似的患者（APC-efTOR 26 例；ESD-efTOR 15 例）。主要目的是减少 GJA 直径和破裂的缝线。评估技术成功率、并发症、总减重（TWL）以及术后 3 个月和 12 个月的总减重百分比（%TWL）和多余减重百分比（%EWL）。
ESD-efTOR 导致破裂缝线明显减少（20%比 69%； = 0.004），术后 3 个月 GJA 缩小更明显（大口径 20%比 0%；小口径 54%比 37%；无缩小 13%比 58%； = 0.02）。技术效果、检查时间和并发症发生率相当。
与 APC-efTOR 相比，ESD-efTOR 可显著减少 GJA 直径并降低缝线破裂风险。
