Key result
Clip-based endoscopic anastomotic reduction proves feasible, reducing anastomotic surface area by ~93% immediately post-procedure.
Why the study?
Dumping syndrome and post-bariatric hypoglycemia are common after RYGB, motivating evaluation of the technical feasibility and short-term clinical effects of a new clip-based endoscopic system.
Does clip-based endoscopic anastomotic reduction improve anastomotic diameter and symptoms in adult patients with dumping syndrome and post-bariatric hypoglycemia after Roux-en-Y gastric bypass?
Does clip-based endoscopic anastomotic reduction improve anastomotic diameter and symptoms in adult patients with dumping syndrome and post-bariatric hypoglycemia after Roux-en-Y gastric bypass?
Effect estimate: 93.2% relative reduction (95% CI 91.1-95.2)
Absolute Event Rate: 63.6% vs 1243.8%
p-value: p=<0.001
Clip-based endoscopic anastomotic reduction is technically feasible and significantly improves anastomotic diameter, dumping syndrome symptoms, and quality of life at 12 weeks in patients after Roux-en-Y gastric bypass.
May support short-term symptom relief with clip-based TORe in post-RYGB DS/PBH; hypothesis-generating, RCTs needed before adoption.
Background and Aims: Dumping syndrome (DS) and post-bariatric hypoglycemia (PBH) represent common complications after Roux-en-Y gastric bypass (RYGB). Transoral outlet reduction (TORe) addresses the rapid passage of food through the gastrojejunal anastomosis which is central in pathophysiology. In this prospective multicenter study, technical feasibility and short-term influence on clinical parameters of a new clip-based endoscopic system (BARS) were evaluated. Methods: Twenty-three consecutive patients at three centers in Germany were included. The primary endpoint was feasibility measured as reduction of anastomotic diameter and surface. Secondary endpoints included changes of the Dumping symptom score and glycaemia in modified oral glucose tolerance tests (mod. oGTT), anastomotic diameter, quality of life after 12 weeks and adverse events. Results: The procedure was technically feasable in all cases. Median anastomotic diameter was reduced from 40 mm (IQR: 30-50) to 9 mm (IQR: 7-10); -77%) at baseline (p<0.001). At week 12, median Sigstad-Score decreased from 17,5 (IQR: 12.8-21.0) to 5 (IQR: 0-11; p <0.001). Median anastomotic diameter was still reduced to 20mm (IQR: 12-30; p= 0.004; -47%). Modified oGTT demonstrated abolished DS in 3 of 23 patients (13%) while no effect was seen in PBH at 12 weeks. Median BMI decreased from 30.6 kg/m2 (IQR: 28-35.6) to 29.25 kg/m2 (IQR: 26.7-33.4; p=0.001). Quality of life (QoL) improved significantly in five of eight subcategories of the SF-36. Conclusion: Clip-based anastomotic reduction for DS and PBH seems feasible, safe and showed significant improvements in Sigstad scores and QoL in short-term analysis.
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Kuellmer et al. (2026) studied Dumping syndrome and post-bariatric hypoglycemia after Roux-en-Y gastric bypass (n=23). Clip-based Endoscopic Anastomotic Reduction (BARS) vs. Baseline was evaluated on Feasibility measured as reduction of anastomotic surface area (93.2% relative reduction, 95% CI 91.1-95.2, p=<0.001). Clip-based endoscopic anastomotic reduction was technically feasible in all patients, significantly reducing the median anastomotic surface area by 93.2% immediately post-procedure.
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