Relly Reicher, Mati Shnell, Aviv Cohen Nathaniel, Fishman Sigal
Bariatric Endoscopy Service, Department of Gastroenterology and Liver Disease, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Weizman 6 st., 6423906, Tel Aviv, Israel.
Surg Endosc. 2021 Dec;35(12):6846-6852. doi: 10.1007/s00464-020-08190-3. Epub 2021 Jan 4.
Dumping syndrome (DS) is a common complication of bariatric surgery. Treatments include dietary and behavioral changes, as well as pharmacotherapy and revision surgery. All can be costly or hard to adhere to. In recent years, evidence accumulates in favor of endoscopic trans-oral outlet reduction (TORe) as an effective treatment for DS, targeting the pathophysiology of rapid gastric clearance. The objective of this study is to assess the safety and efficacy of TORe for DS in a single referral center.
Patients after bariatric surgery suffering DS were followed, and data were retrospectively analyzed. Diagnosis and post-procedural assessment of DS were made clinically using Sigstad score. During the procedure, the anastomotic rim was cauterized. Afterwards, 2 non-interrupted "8-figure" sutures were placed, resulting in imbrication of additional gastric tissue on top of the anastomosis and narrowing to <1 cm at the end of the procedure. Patients were instructed to keep a liquid diet for 14 days and follow-up continued for 6 months.
Between 8/2018 and 9/2019 TORe was carried out in 13 patients (M:F = 3:10) with mean age of 45.1 (range 25-56) and BMI of 33.5 (range 28.1-40.3). Average time since recent surgery was 5.5 years (range 1-9). Mean pre-procedure anastomosis diameter was 25.2 mm (range 15-30) and was reduced to a mean of 5.6 mm (range 5-10). Three patients (23%) were admitted overnight due to inability to drink which resolved spontaneously. No major complications were reported. At 6 months, the Sigstad score was significantly reduced (19.4 ± 3.6 vs 5.2 ± 5.5, P < 0.001), and 11/13 (85%) of patients had a complete resolution of their dumping symptoms. In addition, BMI decreased by a mean of 2.3 kg/m (-1 to 7.5, p = 0.002).
TORe is a safe and effective treatment for patients suffering dumping syndrome and should be considered early in the treatment of DS.
倾倒综合征（DS）是减肥手术的常见并发症。治疗方法包括饮食和行为改变，以及药物治疗和翻修手术。所有这些方法可能成本高昂或难以坚持。近年来，越来越多的证据支持内镜经口缩小出口（TORe）作为一种针对快速胃排空病理生理学的有效DS治疗方法。本研究的目的是评估在单一转诊中心TORe治疗DS的安全性和有效性。
对减肥手术后患有DS的患者进行随访，并对数据进行回顾性分析。使用Sigstad评分在临床上对DS进行诊断和术后评估。在手术过程中，对吻合口边缘进行烧灼。之后，放置2根不间断的“8字”缝线，使吻合口上方的额外胃组织重叠，手术结束时吻合口缩小至<1厘米。患者被要求保持流食14天，并持续随访6个月。
在2018年8月至2019年9月期间，对13例患者（男：女=3：10）进行了TORe手术，平均年龄为45.1岁（范围25 - 56岁），BMI为33.5（范围28.1 - 40.3）。距最近一次手术的平均时间为5.5年（范围1 - 9年）。术前吻合口平均直径为25.2毫米（范围15 - 30毫米），术后缩小至平均5.6毫米（范围5 - 10毫米）。3例患者（23%）因无法饮水而留院观察一晚，症状自行缓解。未报告重大并发症。在6个月时，Sigstad评分显著降低（19.4±3.6对5.2±5.5，P<0.001），13例患者中有11例（85%）倾倒症状完全缓解。此外，BMI平均下降2.3kg/m（-1至7.5，p = 0.002）。
TORe是治疗倾倒综合征患者的一种安全有效的方法，在DS治疗中应尽早考虑。
