Endoscopic reversal of gastric bypass for severe malnutrition after Roux-en-Y gastric bypass surgery

Severe malnutrition has been reported in 4% of patients after Roux-en-Y gastric bypass surgery. This condition leads to hospitalization in 54% of patients, with a mortality rate of 18%. The common causes of severe malnutrition after bariatric surgery include surgical mechanical adverse events and noncompliance with nutritional supplements. The treatment involves nutritional support and correction of the underlying causes; surgical reversal is required in some cases. 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. 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 (Fig. 1; Video 1, available online at www.giejournal.org). 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.