A Prospective Study Evaluating The Utility of Transnasal Endoscopy With Roux en Y Gastric Bypass
Condition: Obesity
MeSH terms: Obesity
Study type: Observational

Summary: 
      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
    

Detailed description: 
      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
    

Intervention name(s): Endoscopy
Intervention type(s): Procedure
Intervention description(s): Transoral endoscopy versus transoral endoscopy
Other intervention name(s): Endoscopy performed transnasally with a slim scope; Transoral endoscopy with a routine diagnostic endoscope
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        This pilot study will attempt to recruit 20 subjects over one year.
      
Keywords: Transnasal; Transoral; Roux en Y gastric bypass; Upper Endoscopy; Obesity