Studies show that more than 90 percent of bariatric patients lose 50 percent or more of their excessive body weight and are able to maintain a long-term weight loss of 50 percent excess body weight or more. (1) Of even greater significance, many bariatric surgery patients experience improvements in co-occurring disorders, such as the resolution of sleep apnea or improvements in hypercholesterolemia and hypertension. Some types of bariatric surgery also lead to improvements or the remission of type 2 diabetes mellitus which, prior to bariatric surgery, was thought to be a progressive and incurable disease requiring lifelong medication and lifestyle modification.
In recent years, however, published research has demonstrated that sustained weight loss can be difficult for some bariatric surgery patients, including even those who experience initial success. Most patients reach their maximum weight loss one to three years following surgery, and research shows that, on average, patients regain about 30 percent of their weight-loss after 10 years. About one-quarter of patients regain all of their lost weight by 10 years. Moreover, about 20 percent of patients who undergo bariatric surgery fail to lose significant weight - defined as less than 50 percent of excess body weight loss.
Weight regain is likely to be linked to a number of factors including:
Many bypass patients who regain weight are mystified, frustrated and plagued by feelings of failure. Bariatric surgeons rarely recommend a second bypass surgery due to the increased risks associated with a repeat surgery. Primary care doctors may feel they have run out of solutions to help these patients.
Endoscopic suturing for bariatric revision provides an additional option to help these patients jump start the weight-loss process. The procedure involves insertion of an endoscope through the mouth (under monitored anesthesia) and assessing the stomach and intestines. If the pouch and/or stoma has been stretched, sutures can be placed to reduce the pouch size and opening. The result is a retightened structure that prompts renewed feelings of satiety to curb food intake.
Key points regarding endoscopic suturing for bariatric revision:
To optimize the chance of successful weight loss, prospective patients receive a consultation with a dietitian prior to surgery as well as follow-up counseling after the procedure. The patient is re-educated about the type of diet that should be followed post-surgery to avoid complications, facilitate weight loss and maintain long-term weight loss.
A follow-up appointment with the surgeon is scheduled for one month after the procedure.
Endoscopic suturing for bariatric revision has been studied for more than a decade. A study published in 2013 in the journal Gastroenterology on patients who had weight regain after RYGB compared 50 patients who had endoscopic suturing for bariatric revision (also called transoral outlet reduction, or TORe) with patients who had a sham procedure. Patients who received endoscopic suturing experienced a 3.5 percent weight loss compared to 0.4% among the patients who underwent a sham procedure. (2). No significant procedure related complications occurred.
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