Endoscopic Suturing for Weight Gain After Bariatric Surgery

研究表明，超过90%的肥胖患者减掉了50%或更多的超重体重，并且能够长期保持减掉50%或更多的超重体重. (1) Of even greater significance, 许多减肥手术患者的并发疾病得到改善, 例如睡眠呼吸暂停的解决或高胆固醇血症和高血压的改善. 某些类型的减肥手术也可以改善或缓解2型糖尿病, prior to bariatric surgery, 被认为是一种进行性和无法治愈的疾病，需要终生服药和改变生活方式.

Endoscopic suturing to jumpstart weight loss

In recent years, however, 已发表的研究表明，对一些减肥手术患者来说，持续减肥可能很困难, including even those who experience initial success. 大多数患者在手术后一到三年达到最大减肥效果, and research shows that, on average, patients regain about 30 percent of their weight-loss after 10 years. 大约四分之一的患者在10年内恢复了所有的体重. Moreover, 大约有20%的患者接受了减肥手术，但体重没有明显减轻——定义为体重减轻的幅度小于体重减轻的50%.

体重反弹可能与以下几个因素有关:

• Over time, the pouch can expand, 允许个人吃更多的食物而不感到饱，并开始一个阴险的过程体重增加.
• The stoma can also stretch.
• 瘘管可以在胃袋和胃其余部分的连接处形成. 这是一个不正常的路径，当较小的胃袋生长并重新连接到旁路的胃. It occurs in 1 to 2 percent of patients.
• The patient's diet and exercise habits change. 例如，饮用高热量饮料往往会导致体重逐渐增加.

许多心脏搭桥手术的患者体重恢复后都感到困惑、沮丧，并被失败的感觉所困扰. 减肥外科医生很少推荐第二次搭桥手术，因为重复手术的风险增加. 初级保健医生可能会觉得他们已经没有办法帮助这些病人了.

内窥镜缝合减肥修正提供了一个额外的选择，帮助这些患者开始减肥过程. 该过程包括通过口腔插入内窥镜(在麻醉监测下)并评估胃和肠. If the pouch and/or stoma has been stretched, sutures can be placed to reduce the pouch size and opening. 结果是一个重新收紧的结构，促使人们重新产生饱腹感，从而抑制食物摄入.

Key points regarding endoscopic suturing for bariatric revision

• 适用于胃分流手术后体重恢复或未能显著减轻的人群
• Addresses enlargement of the pouch and stoma
• Requires overnight fast prior to surgery but no bowel preparation
• Typically a one-hour outpatient procedure; may require an overnight stay to treat pain or nausea
• Minimal risks, such as those associated with any endoscopic surgery
• Proven efficacy
• 手术后一个月需要严格限制饮食并持续改变生活方式(饮食和运动)

After the procedure

To optimize the chance of successful weight loss, 准患者在手术前接受营养师的咨询，并在手术后接受后续咨询. 再次教育患者术后应遵循的饮食类型，以避免并发症, facilitate weight loss and maintain long-term weight loss.

与外科医生的后续预约安排在手术后一个月.

Results

内镜下缝合减肥手术已经研究了十多年. 2013年发表在《皇冠hga020电脑版》(Gastroenterology)杂志上的一项研究比较了50名接受内窥镜缝合进行减肥修复(也称为经口出口缩小)的患者，该研究针对RYGB术后体重恢复的患者, 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.

Frequently asked questions

• How much weight will I lose?
  • About 20 to 50 lbs. depending on an individual anatomy and motivation to succeed.
  • Can I continue to take medications after surgery?
    患者在手术后的第一周应避免服用药片，尽可能选择液体药物. 在手术前与你的初级保健医生和专家讨论你的药物选择.
  • Will I need to follow a specific diet following surgery?
    Yes. Patients should adhere to a restricted diet, similar to the diet followed after the original RYGB surgery, 一个月后进行长期节食，以维持减肥效果.
  • When can I return to work?
    Most patients can return to work after one day.
  • 如果你做过其他类型的减肥手术，比如胃束带，你还会有这种情况吗?
    No. 该手术适用于因胃袋和/或胃造口拉伸而体重恢复的RYGB患者.

Health insurance coverage / cash pricing

• Will my health insurance cover this procedure?
  • We can try to submit the procedure for insurance approval, as some insurances do provide coverage for the ESG. However, many still do not. 皇冠hga025大学洛杉矶分校将提供该手术的预估自付费用, appointments with the endoscopists, and nutrition team visits.
• 皇冠hga025大学洛杉矶分校健康中心提供现金定价的选择服务，包括内窥镜治疗减肥. Follow the instructions below to view:
  • Go to http://l4he.mokmingsky.com/patients-families/billing-insurance/price-transparency/cash-pricing
  • 点击黄色圆圈中名为“消化系统”的“人物”
  • On the drop down menu, 命名为“选择程序或手术”，根据您需要的程序选择内镜胃套管或胃旁路修复

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