sodium-morrhuate and Dilatation--Pathologic

Endoscopic sclerotherapy using sodium morrhuate has been used to treat patients with weight regain after Roux-en-Y gastric bypass whose presumed etiology is loss of restriction due to gastrojejunostomy dilation. Weight loss and stability have been demonstrated in several studies with short-term follow-up evaluation.. This retrospective review evaluated all the patients who underwent sclerotherapy for a dilated gastrojejunostomy between 2007 and 2012.. The study identified 48 patients with a mean follow-up period of 22 months (range 12-60 months). The mean age of these patients was 47.5 ± 10.5 years, and 92 % were women. The average weight loss from the primary procedure was 132.5 ± 54.82 lb, and the average weight regain from the lowest weight to the maximum weight before sclerotherapy was 46 ± 40.32 lb. The median number of sclerotherapy sessions was two (range 1-4). The pre-procedure mean gastrojejunostomy diameter was 20 ± 3.6 mm, and the mean volume of sodium morrhuate injected per session was 12.8 ± 3.7 ml. The average weight loss from sclerotherapy to the final documented weight was 3.17 ± 19.70 lb, which was not statistically significant. The following variables in the multivariate analysis were not associated with statistically significant weight loss: volume of sodium morrhuate, patient age, gastrojejunostomy diameter, number of sclerotherapy sessions, decrease in gastrojejunostomy diameter between the first and second sessions, and number of follow-up years. Weight stabilization or loss was achieved by 58 % of our cohort, with a mean weight loss of 15.9 ± 14.6 lb in this subgroup.. The long-term follow-up evaluation of patients undergoing sclerotherapy of the gastrojejunostomy for weight regain after gastric bypass showed only a marginal weight loss, which was not statistically significant in our study population, although more than 50 % of the patients achieved weight loss or stabilization.

Topics: Dilatation, Pathologic; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastric Bypass; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Time Factors; Treatment Outcome; Weight Gain

Roux-en-Y gastric bypass is an excellent option for weight loss in the morbidly obese. Unfortunately, some patients do have weight regain or insufficient weight loss. Revisional bariatric surgery is not without risk. Less invasive techniques may provide alternative treatments for patients that regain weight or have insufficient weight loss. This video demonstrates a technique of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass.. The technique is applied to patients who have had weight regain or insufficient weight loss following gastric bypass. Patients who have lost the feeling of satiety, undergone reeducation and recounseling of dietary changes, and have documented dilated gastrojejunostomy on upper endoscopy and/or a barium study are offered this technique. If the gastojejunostomy is larger than 12 mm, sodium morrhuate is injected with an endoscopic needle circumferentially.. The gastrojejunostomy is injected with 6-30 cc of sodium morrhuate. By visual inspection, the anastomosis usually appears smaller after the procedure. Most patients report a subjective feeling of satiety after the endoscopic sclerotherapy. Reinjection after 3 months has been performed in some patients. Except mild nausea, the patients have experienced no morbidity or mortality from the procedure.. Endoscopic sclerotherapy may offer an alternative treatment for dilated gastrojejunostomy after gastric bypass. The technique described in the video is a relatively easy, safe method that may become the first line of therapy in patients who have a dilated gastrojejunostomy and have lost the feeling of satiety after gastric bypass with an associated weight gain.

Topics: Dilatation, Pathologic; Endoscopy; Gastric Bypass; Humans; Injections; Obesity; Reoperation; Satiation; Sclerotherapy; Sodium Morrhuate; Treatment Failure

Obesity affects more than 30% of the U.S. population and is associated with the development of life-threatening complications. Numerous therapeutic approaches to the problem have been advocated, including low-calorie diets, anoretic drugs, behavior modifications, and exercise therapy. The only treatment proven to be effective in the long-term management of morbid obesity is surgical intervention. Complications of bariatric surgery include stomal stenosis and/or ulcer and stomal dilation (secondary to overeating). The latter complication can result in a gain of previously lost weight.. To determine the effect of endoscopic injection by using a sclerosant (sodium morrhuate) to induce stomal stenosis in patients who present with stomal dilatation complicated by weight gain.. Bariatric patients with a large gastric stoma were treated with sodium morrhuate stomal injection. Diameters of the stoma were followed at repeat endoscopy. Weight loss at scheduled clinic visits were compared with pretherapy weights.. Twenty-eight patients (10 men, 18 women; age range, 27-58 years), after bariatric surgery with GI bypass, were referred with weight gain after initial weight loss. Weight gain was believed to be the result of a large gastric stoma.. Treatment included injection of sodium morrhuate (1-2 mL circumferentially) surrounding the stoma. A total of 1 to 3 injection sessions were performed in an attempt to achieve a stoma diameter of 1.2 cm or smaller.. Treatment success was defined as a decrease of stoma size to or=75% of the weight the patient gained after establishing a steady state post bariatric surgery weight.. A total of 2.3 injection sessions were performed. Successful endotherapy was achieved in 18 of 28 patients (64%). One patient developed symptoms of stomal stenosis, which required 2 separate balloon dilating sessions. No other complications were encountered.. Retrospective case series.. Endoscopic injection of sodium morrhuate surrounding the dilated gastric stoma complicating bariatric surgery appears to be a successful, less-invasive therapeutic alternative to surgical revision.

Topics: Adult; Dilatation, Pathologic; Endoscopy, Gastrointestinal; Female; Gastric Bypass; Humans; Injections; Male; Middle Aged; Obesity, Morbid; Reoperation; Sclerosing Solutions; Sodium Morrhuate; Surgical Stomas; Weight Gain

Topics: Dilatation, Pathologic; Endoscopy, Gastrointestinal; Gastric Bypass; Humans; Injections; Obesity, Morbid; Reoperation; Sclerosing Solutions; Sodium Morrhuate; Surgical Stomas; Weight Gain