47 - Durability and Weight Outcomes of the Bariatric Anastomotic Reduction System Clips in Patients With Refractory Weight Regain After (RYGB) Gastric Bypass Surgery: A 1-Year Follow-Up Study

Maryam Alkhatry, MD¹, Mohammad Al-Haddad, MD, FACG², Fedaa Housen, MD¹, Bashar Almasri, MD, PhD¹, Hayder Makki, MD³, Farah Soukieh, MBBCh^4
1IBHOH Emirate Health Services, RAK, Ras Al Khaimah, United Arab Emirates; ²Indiana University School of Medicine, Indianapolis, IN; ³IBHOH Emirate Health Services, Sharjah, Sharjah, United Arab Emirates; ⁴Emirates Health Services, Sharjah, Sharjah, United Arab Emirates

Introduction: Roux-en-Y Gastric Bypass (RYGB) is an effective bariatric procedure; however, refractory weight gain (RWG) and dumping syndrome occur in a considerable proportion of patients. Anatomic factors such as dilation of the gastro-jejunostomy (GJ) anastomosis were incorporated as predictors of RWG. Although redo surgery and endoscopic interventions showed effective weight loss in RWG patients, they are associated with high costs and limited evidence of long-term results. The BARS, a new, specialized version of the OTSC®-system, was developed to enhance endoscopic luminal reduction and address the limitations of the original system and performed well in pre-clinical and clinical settings.

We evaluate the durability and efficacy of the BARS system in individuals with (RWG) following RYGB gastric bypass with dilated GJ anastomosis and highlight its potential in improving symptoms of dumping syndrome.

Methods: This pilot retrospective study included nine patients (females =8, median age =45 [range 29 – 52] years) with RWG of ≥10% and enlarged gastrojejunostomy >20mm. The median duration between the bypass and BARS procedures was 58 (range 46 – 67) months, and the median GJ anastomosis size was 23 (range 21 – 25) mm. All patients underwent the single-channel endoscopy of the BARS system (Ovesco Endoscopy). The primary endpoint was to assess the durability of BARS clips during follow up endoscopy at 3, 6, and 12 months (Figure1). The secondary endpoints were weight reduction and the improvement of dumping syndrome which was reported in two patients according to Sigstad Scoring for Dumping Symptoms.

Results: The duration of follow-up was 12 months. The median post-interventional GJ anastomosis size decreased to 8 (6 – 10) mm at month 12, representing a statistically significant median reduction of 63.6% (p =0.007, Figure 2). One patient lost the clips at 6 months. Likewise, the median total weight loss one year after BARS was 11.3 (range 6 – 13.9) Kg,

with a statistically significan reduction of 11.4% (p =0.008, Figure 3). Two patients with dumping syndrome improved significantly after BARS according to Sigstad Scoring system.

Discussion: The BARS clips showed durability within one year of follow up with significant weight reduction, supporting BARS as a safe and effective alternative option to redo surgery in patients with RWG with endoscopically proven dilated anastomosis post RYGB. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.



Disclosures:


Maryam Alkhatry, MD¹, Mohammad Al-Haddad, MD, FACG², Fedaa Housen, MD¹, Bashar Almasri, MD, PhD¹, Hayder Makki, MD³, Farah Soukieh, MBBCh⁴, 47, Durability and Weight Outcomes of the Bariatric Anastomotic Reduction System Clips in Patients With Refractory Weight Regain After (RYGB) Gastric Bypass Surgery: A 1-Year Follow-Up Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.