Endoscopic anti-reflux procedure following bariatric surgery

How is reflux treated after bariatric surgery?

Reflux is a very common symptom following bariatric surgery, and often symptoms persist despite medications and lifestyle measures.  Reflux is most common in patients who have undergone laparoscopic sleeve gastrectomy.

Traditionally the only surgical treatment for reflux is a procedure called the fundoplication.  In patients who have had bariatric surgery, this is not possible due to changes in the anatomy following surgery.

Your bariatric surgeon may recommend further surgery if reflux remains an issue, and a Roux-en-Y gastric bypass (RYGB) can improve reflux.  However, revisional bariatric surgery may be technically challenging and pose a significant risk of complications.

What are the surgical options?

A newer endoscopic approach called the resection and plication (RAP) has been developed whereby a combination of techniques already widely used in endoscopy are used to tighten the lower oesophageal sphincter (LOS).  Mucosal resection (using devices already used for Barrett’s therapy) and endoscopic suturing (used for closing large mucosal defects, perforations and leaks) is used to essentially reconstruct the LOS.  Dr Gupta is the first interventional gastroenterologist in NSW and the second in the country to perform these procedures.

Why use the RAP Procedure?

The RAP procedure has been shown to significantly improve reflux in highly selected individuals.  It is performed as a day only procedure under intravenous sedation, and takes up to an hour in total.  The risks are very low and will be discussed in more detail during your consultation with Dr Gupta.

References

  1. Initial experience with a novel resection and plication (RAP) method for acid reflux. Petros Benias et al. Endosc. Intl Open 2018 April; 6 (4) E443-E449

Further Information

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