Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass

Barham K Abu Dayyeh, David B Lautz, Christopher C Thompson, Barham K Abu Dayyeh, David B Lautz, Christopher C Thompson

Abstract

Background & aims: Weight regain after Roux-en-Y gastric bypass (RYGB) is associated with reductions in health status and quality of life. We evaluated whether gastrojejunal stoma diameter is a risk factor for weight regain after RYGB.

Methods: We examined data collected over 4 years from consecutive patients referred to a tertiary care bariatric center for upper endoscopy after RYGB. We used linear regression analysis to determine the association between the gastrojejunal stoma diameter and weight regain. We applied a logistic regression model using clinical and endoscopic parameters to develop a prediction rule for weight gain after RYGB.

Results: Among 165 patients included in our study, 59% had significant weight regain (≥ 20% of maximum weight lost after the RYGB) and 41% did not. The mean percentage of maximal weight lost after RYGB that was regained in the entire cohort was 30% ± 22%. Gastrojejunal stoma diameter was associated significantly with weight regain after RYGB surgery in univariate analysis (β = .31, P < .0001). This association remained significant after adjusting for several known or purported risk factors for weight regain (β = .19, P = .003). We developed a simple prediction rule for weight regain after RYGB using a 7-point scoring system that includes the gastrojejunal stoma diameter, race, and percentage of maximal body weight lost after RYGB; a cut-off score of 4 or more points had an area under receiver operating characteristic curve of 0.76 and a positive predictive value of 75%.

Conclusions: Increased gastrojejunal stoma diameter is a risk factor for weight regain after RYGB and can be incorporated in a novel prediction rule.

Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Endoscopic measurement technique of the gastrojejunal stoma diameter. A flexible calibrated measuring instrument is introduced through the upper endoscope working channel and placed in proximity to the GJ stoma. The endoscopist recorded its maximal diameter.
Figure 2
Figure 2
Scatter plot with best fit linear regression line and 95% confidence intervals of the association between the gastrojejunal stoma diameter in millimeters and percent of maximal weight lost after RYGB that was regained. The normal distribution of each of the continuous variables is also shown.
Figure 3
Figure 3
Predicted percent of maximal weight lost after RYGB that was regained in 5 years after the procedure at different gastrojejunal stoma diameters based on the linear regression model.
Figure 4
Figure 4
Area under ROC curve for weight regain after RYGB prediction model including gastojejunal stoma diameter, race, and percent of maximal weight loss after RYGB.

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