Department of Surgery, Albany Medical Center, Albany, New York, USA.
Albany Medical College, Albany, New York, USA.
Gastrointest Endosc. 2022 Oct;96(4):639-644. doi: 10.1016/j.gie.2022.04.1306. Epub 2022 Apr 30.
Gastrojejunostomy stomal dilation is a frequent cause of weight regain after Roux-en-Y gastric bypass and may be a contributing cause of dumping syndrome. This study aims to evaluate the long-term durability of endoscopic gastrojejunostomy revision (EGJR) to resolve dumping syndrome.
A retrospective chart review was performed of patients undergoing EGJR at a single institution from January 1, 2013 to December 1, 2018. The primary endpoint, dumping symptom resolution, was measured at 1 month and at the most recent postoperative follow-up. Continuous data are reported as mean and standard deviations and categorical data as percentages. The Fisher exact test was used to assess associations between categorical variables.
Ninety-eight patients underwent EGJR for dumping syndrome. Mean patient age was 51 years (standard deviation [SD], 9.9), and mean body mass index (BMI) was 36.2 kg/m (SD, 7.1), with most patients (53%) presenting with BMIs ≥35 kg/m. Thirty-two patients (32%) reported severe dumping (≥3 symptoms). All patients were followed-up for 1 month, and 83% had a long-term follow-up at a mean of 3.45 years (SD, 1.7) after EGJR. In addition, 88% had initial symptom resolution at 1 month, and 85% reported symptom resolution 3 years postoperatively. Patients with GERD had a statistically significant improvement in dumping syndrome at 3 years compared with those without GERD (69% vs 62%, P = .03). Long-term weight loss averaged 2.1 pounds after EGJR.
EGJR is associated with effective and durable resolution of dumping syndrome at 3 years postoperatively, with a minimal long-term impact on weight loss. The presence of GERD preoperatively correlates with a statistically significant resolution of dumping syndrome.
胃空肠吻合口扩张是 Roux-en-Y 胃旁路术后体重反弹的常见原因，可能也是倾倒综合征的致病因素之一。本研究旨在评估内镜胃空肠吻合口修正术（EGJR）治疗倾倒综合征的长期效果。
回顾性分析了 2013 年 1 月 1 日至 2018 年 12 月 1 日在单家医疗机构接受 EGJR 的患者的病历。主要终点为术后 1 个月和最近一次随访时的倾倒症状缓解情况。连续数据以平均值和标准差表示，分类数据以百分比表示。采用 Fisher 确切检验评估分类变量之间的相关性。
98 例患者因倾倒综合征而行 EGJR。患者平均年龄为 51 岁（标准差 [SD]，9.9），平均 BMI 为 36.2 kg/m（SD，7.1），其中大多数患者（53%）BMI≥35 kg/m。32 例（32%）患者报告有严重倾倒（≥3 种症状）。所有患者均随访 1 个月，83%的患者在 EGJR 后平均 3.45 年（SD，1.7）时进行了长期随访。此外，88%的患者在术后 1 个月时初始症状缓解，85%的患者在术后 3 年时报告症状缓解。与无胃食管反流病（GERD）的患者相比，有 GERD 的患者在术后 3 年时倾倒综合征的改善具有统计学意义（69%比 62%，P=0.03）。EGJR 后平均长期体重减轻 2.1 磅。
EGJR 与术后 3 年倾倒综合征的有效且持久缓解相关，对长期体重减轻的影响极小。术前存在 GERD 与倾倒综合征的统计学显著缓解相关。
