Endoscopic reversal of gastric bypass

Saowanee Ngamruengphong, MD, from the Department of Medicine and Division of Gastroenterology and Hepatology at the Johns Hopkins Medical Institution in Baltimore, Maryland, USA describes this VideoGIE case, “Endoscopic reversal of gastric bypass for severe malnutrition after Roux-en-Y gastric bypass surgery.”

A 38-year-old woman who had undergone Roux-en-Y gastric bypass surgery was admitted with ongoing weight loss and anorexia. Her body mass index (BMI) was 16. She had had multiple hospitalizations because of malnutrition and dehydration. An extensive workup including abdominal imaging studies and deep enteroscopy was unrevealing. She underwent endoscopic reversal of her gastric bypass by creation of a gastrogastric fistula and placement of a partially covered esophageal stent across the gastrogastric fistula.

The patient recommenced her diet, gained weight, and did not need further hospitalization. After removal of the bridging stent, the gastrogastric fistula was patent. Her BMI remained at 18 at 2 years of follow-up.

Figure 1. Endoscopic fistulization and stent bridge of the functional and defunctionalized stomach. A, Bridging stent placed across gastrogastric fistula; contrast medium injected from the distal esophagus passing through the stent and entering the defunctionalized stomach. B, Endoscopic view of patent gastrogastric fistula after stent removal.

In patients with severe malnutrition after Roux-en-Y gastric bypass surgery, surgical reversal is sometimes required. In this video, we demonstrate endoscopic fistulization and stent bridge of the functional and defunctionalized stomach as a therapeutic option for severe malnutrition after Roux-en-Y gastric bypass surgery.

Endoscopic fistulization is a viable option for this serious condition which otherwise may require more invasive surgical management.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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