Gastroenterology and Hepatology

The multidisciplinary care team in the Weight Regain Clinic at Mayo Clinic's campus in Rochester, Minnesota, treats people who've had successful gastric bypass surgery for obesity but have started to regain some of the weight they lost.

Specialists from several departments work together to determine the causes of each patient's weight gain. They then recommend and an individualized treatment plan.

Services provided in the weight regain clinic include:

• Endocrinology consultation. An endocrinologist performs an overall medical assessment and reviews possible treatments for weight regain after gastric bypass surgery.
• Nutrition counseling. A registered dietitian reviews eating habits and provides education about meal planning and food choices.
• Psychological support. A psychologist addresses behavioral factors that may contribute to weight regain, focusing on issues such as binge eating and substance abuse.
• X-ray imaging. A radiologist takes a series of X-rays (upper gastrointestinal series) of the small, upper segment of the stomach (stomach pouch) and the larger, bypassed remainder of the stomach. The upper gastrointestinal (GI) series may detect an infrequent complication of gastric bypass known as gastrogastric fistula — an opening between the stomach pouch and the remainder of the stomach.
• Endoscopy. In this procedure, a specialist in digestive diseases (gastroenterologist) examines the inside of the stomach pouch and its connection to the small intestine (gastrojejunal stoma) using a small camera at the end of a long, narrow, flexible tube (endoscope) passed through the mouth and esophagus. A dilated gastrojejunal (GJ) stoma has been linked to weight regain. Usually, the diameter of the GJ stoma is about 10 millimeters. In those who regain weight after gastric bypass surgery, the GJ stoma can be dilated, contributing to the weight regain.
• Surgical or endoscopic revision. If the upper-GI series finds a gastrogastric fistula, a surgeon or GI endoscopist can repair the fistula with either a surgical procedure or an endoscopic procedure. If the GJ stoma is dilated, a GI endoscopist can reduce the size of the stoma without surgery using an endoscopic suturing device. This is a 30-minute outpatient procedure, and you can go home the same day. Patients who underwent endoscopic reduction of their gastrojejunal stoma lost on average between 22 and 33 pounds (between 10 and 15 kilograms).

Research

At Mayo Clinic's campus in Rochester, Minnesota, gastroenterologists, endocrinologists and weight-loss (bariatric) surgery experts are continuing to study the causes of post-bariatric surgery weight regain, as well as to develop treatments. They're also working on innovative ways to manage weight gain after weight-loss surgery. Please inquire about any ongoing studies in this area from one of the team members taking care of you during your evaluation.