Kathlene regained weight after gastric bypass surgery; We helped her lose it again with a minimally invasive procedure

At 315 pounds, Kathlene Meyer faced complications that affected her health. She became pre-diabetic and was experiencing recurring acid reflux. In 2007, to address her co-existing medical conditions, she underwent a gastric bypass – a type of weight-loss bariatric surgery that helps people lose weight by changing how the stomach and small intestine digests food.

She stayed healthy for a time, but in 2020, like so many others, she was diagnosed with COVID-19.

“The first week, the symptoms were really bad. I had diarrhea, fever and no appetite. It took every ounce of my effort to eat.”

After recovering from COVID-19, Kathlene had a routine blood test to check her blood sugar levels. It revealed that her pre-diabetes had turned into Type 2 diabetes. Kathlene’s diet and weight management would become more important than ever. However, she also began experiencing pains in her stomach that almost felt like muscle spasms.

“The pain would speed up and then release,” says Kathlene. “It started becoming more frequent and that’s what led me to go back to my doctor. In the back of my mind, I kept thinking this has something to do with my gastric bypass.”

Kathelene was referred to Long Beach Gastroenterology Associates, and a CT scan was obtained. This raised concerns that she had an intussusception in the proximal small intestine – a condition in which part of the intestine folds into the section ahead of it. This often blocks food or fluid from passing through.

Kathlene began to receive care from Dr. Jose Luis Aranez, who is an interventional gastroenterologists with the Advanced Endoscopy Services at MemorialCare Long Beach Medical Center and with Long Beach Gastroenterology Associates.

Dr. Aranez performed an upper endoscopy, which is a procedure that allowed him to look at the digestive tract using a thin tube with a camera at the end. The visualized small intestine appeared normal, but the standard endoscope wasn’t long enough to fully rule out any abnormalities. Dr. Aranez therefore recommended an Antegrade Balloon Enteroscopy, an advanced endoscopic procedure that utilizes a longer endoscope fitted with a balloon device that helps “telescope” the small intestine to help reach and treat less accessible areas.

During the upper endoscopy, Dr. Aranez discovered that her gastric outlet (the connection between the gastric pouch and small bowel) had also expanded.

“Weight regain can occur in patients with a gastric bypass, which tends to be multifactorial, but from an anatomical perspective this can happen from a gastric-gastric fistula or dilation of the gastric outlet,” says Dr. Aranez.

We discussed a minimally invasive endoscopic procedure known as Transoral Gastric Outlet Reduction (TORe). “This technique combines mucosal ablation by using Argon Plasma Coagulation and full thickness Endoscopic Suturing to help repair the gastric outlet by reducing its size.”

Kathlene was brought to the Advanced Endoscopy Suite at Long Beach Medical Center for a combined outpatient procedure, which included the Antegrade Balloon Enteroscopy and the Transoral Gastric Outlet Reduction (TORe). The balloon enteroscope was advanced to the distal small bowel and fortunately her intussusception had resolved itself and there were no other abnormalities. The TORe procedure was performed next, and the gastric outlet was reduced from 25 mm down to 12 mm. The total of both procedures took 90 minutes and Kathlene returned home the same day.

“We use the latest technology and devices to ensure that any digestive abnormality can be detected, even those that a regular endoscopy may miss,” says Dr. Aranez. “We use these advanced techniques to not only diagnose, but treat a range of digestive conditions, like in Kathlene’s case.”

“Many of the advanced endoscopy treatments we offer allow our patients to avoid traditional surgery because these procedures are minimally invasive, our patients don’t have to stay in the hospital overnight, their overall recovery is quicker and there is no scarring.”

Post-procedure, Kathlene went on a diet of liquid and protein drinks for three weeks followed by a week of pureed food. Now, she’s eating normally again, and has lost 45 lbs. since her procedure. In addition to being back to her post-bypass weight, Kathlene’s blood sugar level are back to normal.

“My primary doctor told me that I am no longer considered diabetic,” says Kathlene. “I no longer need to take Metformin to help my body produce more insulin!”

Kathlene also began incorporating more exercise into her daily life. When she is not hanging out with friends and spending time with her husband, she can be found riding her bike – a commitment to her renewed healthy lifestyle.

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