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Gastric bypass is a highly effective bariatric operation, but failures may occur. Some patients, as many as (10-15%) may present with inadequate weight loss or weight regain after a few years. The number one reason for this failure \ weight gain is due to a patient's behavior (a failure to follow the post-op guidelines).
The next most common cause for this weight gain is due to an anatomical problem within the pouch.
While dilatation of the pouch it self is very rare, more commonly dilatation of the gastro-jejunal anastomosis (the connection between the pouch and your small intestine) is one of the possible explanations for the failure of the gastric bypass. If the anastomosis had become dilated (stretched), then food can pass through the pouch more quickly, allowing a patient to consume a greater amount of food at a meal time and therefore be able to eat more calories. It is this loss of restriction, and increased caloric intake that leads to weight gain, or prevents a patient from losing more weight.
Recognizing that this problem affects many patients, Dr. Jawad has evaluated the treatment options that are available to correct a dilated stoma. Various treatments have been proposed to include Gastric Banding at the stoma site and the new StomaphyX procedure, though both treatments are expensive and lack a proven track record of success. After a thorough review of the available literature, Dr. Jawad has concluded that a procedure called Endoscopic Sclerotherapy is the best treatment option for those with a dilated anastomosis.
Sclerotherapy is performed during a diagnostic Endoscopy, and involves the injection of a sclerosing agent (a chemical that produces scar tissue) in the muscular layer of the stomach around the dilated anastomosis. Over the course of the next 2 months, scar tissue forms around the opening and produces a stricture (or tightening) at the gastro-jejunal junction, making the opening smaller. Once the opening is made
to be smaller, most patients (74%) begin to loose weight or stop gaining weight.
(Click here for a more detailed discussion of the
above referenced studies) 
This procedure is safe, effective, fast and does not require a hospital stay. The surgeon performs the Sclerotherapy during the diagnostic Endoscopy, with the entire procedure taking approximately 30 minutes. You will be able to go home a few hours after the procedure has been completed, and could go back to work the next day. Most patients respond to the first treatment, with only a small percentage (28%) needing a second treatment to make the stoma smaller. The procedure is significantly less expensive than the StomaphyX and Gastric Banding, and is covered by Most Insurance companies.
If you are gaining weight after your Gastric Bypass surgery, or are still struggling to lose weight years later, we are pleased to announce that we are now offering the Endoscopic Sclerotherapy procedure to both our patients, and those whom have had surgery performed by other surgeons. Please call our office to schedule a consultation with our physician, to see if this procedure can help to get you back on track to weight loss.
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