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Endoscopic suture removal at gastrojejunal anastomosis after Roux-en-Y gastric bypass to prevent marginal ulceration.
Surg Obes Relat Dis. 2007 Nov-Dec; 3(6):619-22.SO

Abstract

BACKGROUND

After Roux-en-Y gastric bypass (RYGB) surgery, marginal ulcers develop in 3-23% of patients. Marginal ulcers can occur secondary to the use of nonabsorbable sutures to create the gastrojejunostomy. The suture can elicit a foreign body reaction that exposes it to the gastric lumen, irritating the mucosa. Surgical removal is mandated when medical therapy fails to resolve matters. Because endoscopic removal would be less invasive than laparotomy, a technique for the endoscopic removal of the suture was devised. Presented are the results of 6 patients who underwent this procedure.

METHODS

A computer search of all patients who had undergone laparoscopic RYGB was done and found 6 women who had undergone endoscopic suture removal. After a double-lumen endoscope was inserted through the mouth, a grasper was used to placed the suture under tension before transecting it with blunt-tip endoshears. The suture was then removed without difficulty. All patients were evaluated at 2 weeks and 6 months postoperatively.

RESULTS

Of the patients who underwent laparoscopic RYGB between June 2003 and June 2005 and presented with epigastric pain, 6 women underwent endoscopic stitch removal. These women had a mean age of 57 years, a mean initial body mass index of 55 kg/m(2), and had undergone laparoscopic RYGB a mean of 18 months before presentation. The patients, who had experienced new-onset epigastric pain and "heartburn," underwent endoscopic examination of the stomach, which showed visible suture at the gastrojejunal anastomosis, no ulceration, and edema, and underwent suture removal. No complications developed. At 6 months of follow-up, all patients were without symptoms and had normal findings on upper endoscopy.

CONCLUSION

The results of our study have shown that endoscopic suture removal is a feasible and effective means of treating epigastric pain and preventing the suture-induced marginal ulcers that can occur after RYGB.

Authors+Show Affiliations

Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas 79415, USA. eldo.frezza@ttuhsc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18023815

Citation

Frezza, Eldo E., et al. "Endoscopic Suture Removal at Gastrojejunal Anastomosis After Roux-en-Y Gastric Bypass to Prevent Marginal Ulceration." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 3, no. 6, 2007, pp. 619-22.
Frezza EE, Herbert H, Ford R, et al. Endoscopic suture removal at gastrojejunal anastomosis after Roux-en-Y gastric bypass to prevent marginal ulceration. Surg Obes Relat Dis. 2007;3(6):619-22.
Frezza, E. E., Herbert, H., Ford, R., & Wachtel, M. S. (2007). Endoscopic suture removal at gastrojejunal anastomosis after Roux-en-Y gastric bypass to prevent marginal ulceration. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 3(6), 619-22.
Frezza EE, et al. Endoscopic Suture Removal at Gastrojejunal Anastomosis After Roux-en-Y Gastric Bypass to Prevent Marginal Ulceration. Surg Obes Relat Dis. 2007 Nov-Dec;3(6):619-22. PubMed PMID: 18023815.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic suture removal at gastrojejunal anastomosis after Roux-en-Y gastric bypass to prevent marginal ulceration. AU - Frezza,Eldo E, AU - Herbert,Haleigh, AU - Ford,Ronny, AU - Wachtel,Mitchell S, PY - 2007/05/04/received PY - 2007/06/22/revised PY - 2007/08/24/accepted PY - 2007/11/21/pubmed PY - 2008/2/22/medline PY - 2007/11/21/entrez SP - 619 EP - 22 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 3 IS - 6 N2 - BACKGROUND: After Roux-en-Y gastric bypass (RYGB) surgery, marginal ulcers develop in 3-23% of patients. Marginal ulcers can occur secondary to the use of nonabsorbable sutures to create the gastrojejunostomy. The suture can elicit a foreign body reaction that exposes it to the gastric lumen, irritating the mucosa. Surgical removal is mandated when medical therapy fails to resolve matters. Because endoscopic removal would be less invasive than laparotomy, a technique for the endoscopic removal of the suture was devised. Presented are the results of 6 patients who underwent this procedure. METHODS: A computer search of all patients who had undergone laparoscopic RYGB was done and found 6 women who had undergone endoscopic suture removal. After a double-lumen endoscope was inserted through the mouth, a grasper was used to placed the suture under tension before transecting it with blunt-tip endoshears. The suture was then removed without difficulty. All patients were evaluated at 2 weeks and 6 months postoperatively. RESULTS: Of the patients who underwent laparoscopic RYGB between June 2003 and June 2005 and presented with epigastric pain, 6 women underwent endoscopic stitch removal. These women had a mean age of 57 years, a mean initial body mass index of 55 kg/m(2), and had undergone laparoscopic RYGB a mean of 18 months before presentation. The patients, who had experienced new-onset epigastric pain and "heartburn," underwent endoscopic examination of the stomach, which showed visible suture at the gastrojejunal anastomosis, no ulceration, and edema, and underwent suture removal. No complications developed. At 6 months of follow-up, all patients were without symptoms and had normal findings on upper endoscopy. CONCLUSION: The results of our study have shown that endoscopic suture removal is a feasible and effective means of treating epigastric pain and preventing the suture-induced marginal ulcers that can occur after RYGB. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/18023815/Endoscopic_suture_removal_at_gastrojejunal_anastomosis_after_Roux_en_Y_gastric_bypass_to_prevent_marginal_ulceration_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(07)00623-5 DB - PRIME DP - Unbound Medicine ER -