WHAT IS THE ENDOSCOPIC OUTLET REDUCTION?
Dr Balalis performs the Endoscopic Outlet Reduction procedure as a revision following a gastric bypass. Endoscopic Outlet Reduction is an endoscopic (gastroscopy) suturing system used to place sutures (stitches) on the opening between the stomach and the small bowel (gastric outlet). It is used by Dr Balalis to revise gastric bypass surgery, even many years following the procedure and sometimes referred to as the ‘Overstitch’. This is because the Endoscopic Outlet Reduction is performed using the Apollo Overstitch Device.
Dr Balalis performs laparoscopic gastric bypass operations (both Roux-en-Y or one anastomosis gastric bypass) as weight loss procedures. They involve dividing the stomach to create a small pouch, which is attached to the small bowel after bypassing the rest of the stomach and part of the small bowel.
The gastric outlet (opening between the stomach pouch and the intestine) however may gradually expand with time, increasing the capacity to hold food.
The OverStitch procedure is used to reduce the size of the outlet as well as the stomach pouch to provide restriction for patients following gastric bypass. An Endoscopic Outlet Reduction may be beneficial for some gastric bypass patients with weight regain and is usually performed as a day case procedure.
HOW IS THE OVERSTITCH PROCEDURE PERFORMED?
The procedure is performed under a general anaesthetic and the OverStitch system is inserted by Dr Balalis through an endoscopy to place stitches at the opening between the stomach pouch and intestine to reduce the size of the outlet. Additional stitches may be placed on the wall of the pouch and when tightened reduces the size of the pouch.
The Endoscopic Outlet Reduction accomplishes outlet revision of a gastric bypass without the need for any incisions or operations. The entire procedure may take around an hour, and postoperative pain is usually minimal. Some patients may be better suited to a surgical revision, and it is important to discuss all options with Dr Balalis during your consultation.
WHAT ARE THE EXPECTED WEIGHT LOSS OUTCOMES WITH THIS PROCEDURE?
There have been several studies looking at weight loss outcomes following the Endoscopic Outlet Reduction procedure. It is very difficult to predict how patients will respond to the Endoscopic Outlet Reduction, however in a large multi-centre trial, the proportion of patients achieving ≥5% total body weight loss at 12 months was 67.6%. Overall, over 75% of patients experienced weight gain arrest or stabilisation at 6 and 12 months.
ARE THERE ANY RISKS WITH AN ENDOSCOPIC OUTLET REDUCTION PROCEDURE?
The risks are low, however complications included nausea and abdominal pain, with rare risks including bleeding and perforation.
Contact us to schedule an appointment to discuss the options available and what’s right for you.
 Vargas, E.J., Bazerbachi, F., Rizk, M. et al. Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc 32, 252–259 (2018). https://doi.org/10.1007/s00464-017-5671-1