A Prospective Study Evaluating The Utility of Transnasal Endoscopy With Roux en Y Gastric Bypass

Obesity is an epidemic in the United States effecting 250 million people worldwide and over
30% of the population of the United Sates. Medical therapy for obesity is lacking in its
durability in maintaining weight loss. Currently surgical therapy is the most dependable and
durable treatment option. The Roux en Y gastric bypass (RYGB) was initially described in 1967
and is currently the surgical method of choice in the treatment of obesity. It involves the
creation of a small gastric pouch by restricting the gastric body and antrum and the creation
of a long roux limb with a gastrojejunal anastomosis, thus inducing satiety and creating a
malabsorptive physiology. Unfortunately this procedure maintains a significant complication
rate. Strictures at the gastrojejunal anastomosis occur in 6-20% of patients after bypass.1
Anastomotic ulcers occur in up to 16% .2 Symptoms include vomiting, abdominal pain, and
significant nausea. Unfortunately these symptoms are not specific to strictures or ulcers and
may occur spontaneously without a specific etiology, so often a transoral upper endoscopy
(EGD) is required to evaluate the anastomosis for significant pathology.

EGD in post bariatric patients is a safe procedure. However it typically requires deep
sedation administered by an anesthesiologist to overcome the patient's gag reflex and
discomfort. Sedation in obese patients can be challenging due to the risks of apnea and
challenges of tracheal intubation. For the procedure to be performed the patient must take
the day off from work and bring a driver to take them home, thus there are significant direct
and indirect costs to the procedure.

Improvements in imaging technology have allowed for the development of small endoscopes
("slim scopes") half the size of a typical endoscope. These small endoscopes can be passed
transnasally into the esophagus and stomach with only local anesthesia to the nasal passage
without the need for deep sedation. They have been used in the detection of diseases of the
esophagus and stomach,3,4 but have not been used in the detection of complications in the
post bariatric population

Inclusion Criteria:

- Subjects must be able to review and sign informed consent

- Subjects have undergone Roux en Y gastric bypass

- Subjects report any of the following symptoms that would prompt investigation and
referral for an upper endoscopy; abdominal pain, nausea, vomiting or problems
swallowing

Exclusion Criteria:

- Patients who cannot give and sign informed consent.