Nonsurgical Revisional Procedures

Less-invasive revisional options

We are pleased to offer non-surgical, less-invasive revisional options for patients who previously had bariatric surgery, initially achieved good weight loss results, and slowly over time regained some of the weight back. These are only tools to assist in weight loss, and without any dietary and lifestyle changes, weight loss results can be disappointing.

We highly advocate enrolling in our Back on Track program to maximize weight loss benefits.

These procedures include:

  • Endoscopic reduction of gastric bypass pouch and/or outlet reduction.
  • Endoscopic closure of gastro-gastric bypass fistula causing weight regain or upper intestinal tract issues.
  • Endoscopic sleeve gastrectomy pouch reduction.

Occasionally, when the gastric bypass pouch stretches or the outlet enlarges over time, this could eventually lead to some weight regain as people start losing the satiety feeling and are able to take in more calories.*

Though the best approach in this situation is to get back on track with diet and lifestyle changes, reducing the pouch or outlet size may be a useful tool for some people to aid in losing the extra weight they gained.

Criteria for potential outlet/pouch reduction candidates includes but is not limited to:

  1. BMI 30-40.
  2. 2 years or longer since gastric bypass surgery.
  3. Initially achieved at least 50% of excess weight loss and/or BMI 35 or less.
  4. Lost feeling of satiety.
  5. Chronic dumping syndrome.
  6. Completed successful nutritional education and screening and willing to cooperate with follow-up dietary recommendations.

Exclusion criteria for outlet/pouch reduction includes but is not limited to:

  1. Patients with banded gastric bypass.
  2. Other factors contributing to weight regain other than gastric pouch/outlet enlargement and requiring further attention, such as an eating disorder.
  3. Pregnancy or plans for pregnancy in the next 12 months.
  4. Large hiatal hernia over 3-5 cm.
  5. Severe acid reflux disease uncontrolled with medications.
  6. Weak immune system.
  7. Active substance abuse.
  8. Smokers.
  9. Bleeding disorders or daily use of a blood thinner.
  10. Any active medical condition that would preclude a safe endoscopic procedure. 

*Influence of pouch and stoma size on weight loss after gastric bypass, Bipan Chand. Et al, Gastrojejunal Stoma diameter Predicts Weight Regain after Roux-en-Y Gastric Bypas, Christopher C. Thompson, et al. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up, Nitin Kumar, MD, Christopher C. Thompson, MD, GIE 2015.

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