EUS Directed Trans-gastric Gastroenterostomy for Gastric Remnant Outlet Obstruction after Roux-en-Y Gastric Bypass Surgery

EUS Directed Trans-gastric Gastroenterostomy for Gastric Remnant Outlet Obstruction after Roux-en-Y Gastric Bypass Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report EUS Directed Trans-gastric Gastroenterostomy for Gastric Remnant Outlet Obstruction after Roux-en-Y Gastric Bypass Surgery Victoria Margolis, Rishi Pawa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5769838/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Mar, 2025 Read the published version in Obesity Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract 1. EUS directed gastro-gastrostomy using lumen apposing metal stent has greatly enhanced the ability to perform trans-gastric interventions after Roux-en-Y gastric bypass surgery. 2. The use of this minimally invasive technique in terminally ill patients with gastric outlet obstruction of the excluded stomach allows for prompt diagnosis by providing access to the bypassed stomach and is therapeutic by allowing drainage via the Roux limb. 3. EUS-guided gastroenterostomy (via the excluded stomach) may help in alleviating reflux symptoms in patients following creation of gastro-gastric anastomosis. Background Endoscopic interventions are technically challenging in patients with Roux-en-Y gastric bypass surgery due to the alterations in gastrointestinal anatomy. Endoscopic ultrasound guided creation of gastro-gastric or jejuno-gastric fistula using a lumen apposing metal stent (LAMS) allows direct access to the excluded stomach thereby facilitating trans-gastric interventions 1 . We present a case of EUS-guided gastroenterostomy (EUS-GE) for management of gastric outlet obstruction of the excluded stomach following creation of gastro-gastric anastomoses. Case Presentation A 73-year-old woman presented with 3 weeks of worsening epigastric abdominal pain. She had a past medical history of advanced renal cell cancer, atrial fibrillation, diabetes mellitus, and coronary artery disease. She had a past surgical history of Roux-en-Y gastric bypass in 2011 and an exploratory laparotomy secondary to motor vehicle accident in 2018 with repair of gastrojejunostomy anastomoses. Her laboratory values on presentation were normal. A CT abdomen was obtained showing progressive fluid distention of the excluded stomach. After discussing with the patient and the bariatric surgery team, the decision was made to proceed with EUS-guided creation of gastro-gastric anastomoses to allow access to the excluded stomach. The endoscope was advanced into the gastric pouch where copious amounts of food residue was noted. This was removed using a Roth net. The gastro-jejunostomy anastomosis and small bowel mucosa appeared healthy. The endoscope was then exchanged for a linear echo-endoscope, with visualization of the distended excluded stomach. Under EUS guidance, a 20mm by 10mm electrocautery enhanced LAMS was advanced into the excluded stomach. Following deployment of the proximal phalange, copious amounts of fluid could be seen draining from the excluded stomach into the gastric pouch. Under endoscopic and fluoroscopic guidance, the stent was dilated to 15mm using a wire guided balloon. The endoscope was advanced through the LAMS into the excluded stomach. The distal gastric body and antrum appeared normal. The endoscope was then advanced past the pylorus into the duodenal bulb where abnormal polypoid mucosa was noted, resulting in luminal narrowing. Multiple cold forceps biopsies were obtained. With gentle manipulation and moderate resistance, the endoscope was advanced into the second portion of the duodenum which appeared normal. The patient was discharged home the following day without any complications and on PPI therapy. Pathology results from duodenal biopsies showed tubular adenoma, peptic duodenitis with ulceration, and focal stromal fibrosis. A detailed discussion was held with the patient, HPB surgery, and bariatric surgery teams regarding various treatment options available including endoscopic and surgical resection of the duodenal polyp. Given her history of advanced renal cell cancer and overall poor prognosis, the patient and family elected to forgo any invasive therapeutic interventions. About 6 weeks later, the patient was seen in HPB surgery clinic with complaints of worsening reflux symptoms and epigastric pain despite maximal PPI therapy. This was attributed to increased reflux of gastric contents from the excluded stomach into the gastric pouch. Given the above symptoms, the decision was made to proceed with EUS-guided gastro-enterostomy (from the excluded stomach) to divert the flow of contents from the excluded stomach into the small bowel, thereby decreasing reflux into the gastric pouch. On endoscopy the LAMS was seen in the gastric pouch. A large ulcer was noted at the gastro-jejunostomy anastomosis likely contributing to the patient's symptoms. The LAMS connecting the gastric pouch to the excluded stomach was removed using a rat tooth forceps. The endoscope was advanced through the gastro-gastric anastomosis into the second portion of the duodenum. Under endoscopic and fluoroscopic guidance, a .025 inch in diameter and 450 cm in length straight tip guidewire was advanced into the proximal jejunum. A naso-cystic drain was advanced over the guidewire and left in place at the ligament of Treitz. A mixture of water and contrast with methylene blue was then injected via the naso-cystic drain to opacify the small bowel on fluoroscopy. A dilated loop of small bowel was identified adjacent to the body of the stomach using a linear echoendoscope. A 20mm by10mm electrocautery enhanced LAMS was deployed in the dilated small bowel loop, thereby creating a gastoenterostomy via the excluded stomach. Next, the LAMS removed from the G-G anastomosis was backloaded on a therapeutic endoscope using a snare and deployed at the site of G-G anastomosis. A CT scan was obtained the following day which showed stents in appropriate position. The patient was discharged home on twice daily PPI therapy. Follow-up endoscopy at 4 weeks showed complete resolution of the anastomotic ulcer. At 6 months follow-up, she had no recurrence of symptoms. Conclusion EUS-guided creation of gastro-gastric anastomoses can help alleviate symptoms of gastric outlet obstruction of the bypassed stomach in patients who are poor surgical candidates 2 . In patients experiencing intractable reflux following this procedure, EUS-guided gastroenterostomy (via the excluded stomach) may help in diverting the flow of gastric contents distally into the small bowel thereby preventing reflux. Declarations Ethical Approval : All procedures performed in studies involving human participants were in Informed Consent : Informed consent was obtained from all participants included in the study Conflict of interest : Author 1 has no conflict of interest. Author 2 is a consultant for Boston Scientific and Cook Medical. Funding: No funding was obtained for this article Author Contribution VM performed data collection, drafting, and video editing of the article. RP revised it critically for important intellectual content and approved the version to be published. All authors reviewed the manuscript. References Ghandour B, Shinn B, Dawod QM, Fansa S, El Chafic AH, Irani SS, Pawa R, Gutta A, Ichkhanian Y, Paranandi B, Pawa S, Al-Haddad MA, Zuchelli T, Huggett MT, Bejjani M, Sharaiha RZ, Kowalski TE, Khashab MA; EDGI study group. EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a multicenter experience. Gastrointest Endosc. 2022;96(4):630–638 Zarrin A, Sorathia S, Choksi V, Kaplan SR, Kasmin F. Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report. World J Gastrointest Endosc. 2020;12(9):297–303 Additional Declarations No competing interests reported. Supplementary Files BLINDEDGastricOutletObstructionLAMSGGGJ.mp4 Cite Share Download PDF Status: Published Journal Publication published 04 Mar, 2025 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 23 Jan, 2025 Reviews received at journal 19 Jan, 2025 Reviews received at journal 13 Jan, 2025 Reviewers agreed at journal 13 Jan, 2025 Reviews received at journal 13 Jan, 2025 Reviewers agreed at journal 13 Jan, 2025 Reviewers agreed at journal 13 Jan, 2025 Reviewers invited by journal 13 Jan, 2025 Editor assigned by journal 11 Jan, 2025 Submission checks completed at journal 08 Jan, 2025 First submitted to journal 05 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5769838","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":399556987,"identity":"c7e76dd5-b5d2-414a-9db0-1663eac874b3","order_by":0,"name":"Victoria Margolis","email":"","orcid":"","institution":"Wake Forest Baptist Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"","lastName":"Margolis","suffix":""},{"id":399556988,"identity":"d35ce79e-40ba-492e-8454-431211bd1980","order_by":1,"name":"Rishi Pawa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYDACZgY2hgQQg70ByCZNC88BYrUwALWAgUQCkVrM29mfPXi4wy6xf+Ybw88FFTYM/O3dCXi1yBzmMTdIPJOcOON2jrH0jDNpDBJnzm7Aq0WCmYdNIrGNObfhdo6BNG/bYQYDiVxCWtifAbXU586/ecb4N5FaGMyAWg7nbrjBY0asLTxALWeO1288k1ZmzXMmjYewX/iPP5P8uaPaWO744c23eSps5Pjbe/FrAQPGBhDJYQAieQgrR2hhf0Cc6lEwCkbBKBhxAAAV0UMYGx/dbgAAAABJRU5ErkJggg==","orcid":"","institution":"Wake Forest Baptist Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Rishi","middleName":"","lastName":"Pawa","suffix":""}],"badges":[],"createdAt":"2025-01-06 01:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5769838/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5769838/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-025-07761-4","type":"published","date":"2025-03-04T15:58:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":78190635,"identity":"95a9c01c-8a64-4f8c-97f6-7459a69d13fd","added_by":"auto","created_at":"2025-03-10 19:50:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":264602,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5769838/v1/302b610b-9ff4-40f6-8a61-dc34df14b675.pdf"},{"id":73574180,"identity":"fc932728-999d-414a-9b80-8b45bb59a305","added_by":"auto","created_at":"2025-01-11 19:02:03","extension":"mp4","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":480771693,"visible":true,"origin":"","legend":"","description":"","filename":"BLINDEDGastricOutletObstructionLAMSGGGJ.mp4","url":"https://assets-eu.researchsquare.com/files/rs-5769838/v1/78d019899d5028ca34b6ba40.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"EUS Directed Trans-gastric Gastroenterostomy for Gastric Remnant Outlet Obstruction after Roux-en-Y Gastric Bypass Surgery","fulltext":[{"header":"Background","content":"\u003cp\u003eEndoscopic interventions are technically challenging in patients with Roux-en-Y gastric bypass surgery due to the alterations in gastrointestinal anatomy. Endoscopic ultrasound guided creation of gastro-gastric or jejuno-gastric fistula using a lumen apposing metal stent (LAMS) allows direct access to the excluded stomach thereby facilitating trans-gastric interventions\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. We present a case of EUS-guided gastroenterostomy (EUS-GE) for management of gastric outlet obstruction of the excluded stomach following creation of gastro-gastric anastomoses.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 73-year-old woman presented with 3 weeks of worsening epigastric abdominal pain. She had a past medical history of advanced renal cell cancer, atrial fibrillation, diabetes mellitus, and coronary artery disease. She had a past surgical history of Roux-en-Y gastric bypass in 2011 and an exploratory laparotomy secondary to motor vehicle accident in 2018 with repair of gastrojejunostomy anastomoses. Her laboratory values on presentation were normal. A CT abdomen was obtained showing progressive fluid distention of the excluded stomach. After discussing with the patient and the bariatric surgery team, the decision was made to proceed with EUS-guided creation of gastro-gastric anastomoses to allow access to the excluded stomach.\u003c/p\u003e \u003cp\u003eThe endoscope was advanced into the gastric pouch where copious amounts of food residue was noted. This was removed using a Roth net. The gastro-jejunostomy anastomosis and small bowel mucosa appeared healthy. The endoscope was then exchanged for a linear echo-endoscope, with visualization of the distended excluded stomach. Under EUS guidance, a 20mm by 10mm electrocautery enhanced LAMS was advanced into the excluded stomach. Following deployment of the proximal phalange, copious amounts of fluid could be seen draining from the excluded stomach into the gastric pouch. Under endoscopic and fluoroscopic guidance, the stent was dilated to 15mm using a wire guided balloon. The endoscope was advanced through the LAMS into the excluded stomach. The distal gastric body and antrum appeared normal. The endoscope was then advanced past the pylorus into the duodenal bulb where abnormal polypoid mucosa was noted, resulting in luminal narrowing. Multiple cold forceps biopsies were obtained. With gentle manipulation and moderate resistance, the endoscope was advanced into the second portion of the duodenum which appeared normal. The patient was discharged home the following day without any complications and on PPI therapy. Pathology results from duodenal biopsies showed tubular adenoma, peptic duodenitis with ulceration, and focal stromal fibrosis. A detailed discussion was held with the patient, HPB surgery, and bariatric surgery teams regarding various treatment options available including endoscopic and surgical resection of the duodenal polyp. Given her history of advanced renal cell cancer and overall poor prognosis, the patient and family elected to forgo any invasive therapeutic interventions.\u003c/p\u003e \u003cp\u003eAbout 6 weeks later, the patient was seen in HPB surgery clinic with complaints of worsening reflux symptoms and epigastric pain despite maximal PPI therapy. This was attributed to increased reflux of gastric contents from the excluded stomach into the gastric pouch. Given the above symptoms, the decision was made to proceed with EUS-guided gastro-enterostomy (from the excluded stomach) to divert the flow of contents from the excluded stomach into the small bowel, thereby decreasing reflux into the gastric pouch.\u003c/p\u003e \u003cp\u003eOn endoscopy the LAMS was seen in the gastric pouch. A large ulcer was noted at the gastro-jejunostomy anastomosis likely contributing to the patient's symptoms. The LAMS connecting the gastric pouch to the excluded stomach was removed using a rat tooth forceps. The endoscope was advanced through the gastro-gastric anastomosis into the second portion of the duodenum. Under endoscopic and fluoroscopic guidance, a .025 inch in diameter and 450 cm in length straight tip guidewire was advanced into the proximal jejunum. A naso-cystic drain was advanced over the guidewire and left in place at the ligament of Treitz. A mixture of water and contrast with methylene blue was then injected via the naso-cystic drain to opacify the small bowel on fluoroscopy. A dilated loop of small bowel was identified adjacent to the body of the stomach using a linear echoendoscope. A 20mm by10mm electrocautery enhanced LAMS was deployed in the dilated small bowel loop, thereby creating a gastoenterostomy via the excluded stomach. Next, the LAMS removed from the G-G anastomosis was backloaded on a therapeutic endoscope using a snare and deployed at the site of G-G anastomosis. A CT scan was obtained the following day which showed stents in appropriate position. The patient was discharged home on twice daily PPI therapy. Follow-up endoscopy at 4 weeks showed complete resolution of the anastomotic ulcer. At 6 months follow-up, she had no recurrence of symptoms.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEUS-guided creation of gastro-gastric anastomoses can help alleviate symptoms of gastric outlet obstruction of the bypassed stomach in patients who are poor surgical candidates\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. In patients experiencing intractable reflux following this procedure, EUS-guided gastroenterostomy (via the excluded stomach) may help in diverting the flow of gastric contents distally into the small bowel thereby preventing reflux.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003e \u003cb\u003eEthical Approval\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eAll procedures performed in studies involving human participants were in\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003e \u003cb\u003eInformed Consent\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003e Informed consent was obtained from all participants included in the study\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cb\u003eConflict of interest\u003c/b\u003e:\u003c/strong\u003e \u003cp\u003eAuthor 1 has no conflict of interest. Author 2 is a consultant for Boston Scientific and Cook Medical.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo funding was obtained for this article\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eVM performed data collection, drafting, and video editing of the article. RP revised it critically for important intellectual content and approved the version to be published. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGhandour B, Shinn B, Dawod QM, Fansa S, El Chafic AH, Irani SS, Pawa R, Gutta A, Ichkhanian Y, Paranandi B, Pawa S, Al-Haddad MA, Zuchelli T, Huggett MT, Bejjani M, Sharaiha RZ, Kowalski TE, Khashab MA; EDGI study group. EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a multicenter experience. Gastrointest Endosc. 2022;96(4):630\u0026ndash;638\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarrin A, Sorathia S, Choksi V, Kaplan SR, Kasmin F. Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report. World J Gastrointest Endosc. 2020;12(9):297\u0026ndash;303\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5769838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5769838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e1.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; EUS directed gastro-gastrostomy using lumen apposing metal stent has greatly enhanced the ability to perform trans-gastric interventions after Roux-en-Y gastric bypass surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; The use of this minimally invasive technique in terminally ill patients with gastric outlet obstruction of the excluded stomach allows for prompt diagnosis by providing access to the bypassed stomach and is therapeutic by allowing drainage via the Roux limb.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; EUS-guided gastroenterostomy (via the excluded stomach) may help in alleviating reflux symptoms in patients following creation of gastro-gastric anastomosis.\u003c/p\u003e","manuscriptTitle":"EUS Directed Trans-gastric Gastroenterostomy for Gastric Remnant Outlet Obstruction after Roux-en-Y Gastric Bypass Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-11 19:01:34","doi":"10.21203/rs.3.rs-5769838/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-23T14:00:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-19T15:10:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-14T02:07:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151794567295378363220080648350820126308","date":"2025-01-14T01:23:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-13T18:35:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105140425538207067560226067540157456292","date":"2025-01-13T18:17:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112171589932031764884644205352381803189","date":"2025-01-13T15:10:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-13T14:22:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-11T22:42:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-08T17:13:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2025-01-06T01:30:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"411e6ebb-0bac-40d7-8848-688adaf182e2","owner":[],"postedDate":"January 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-10T19:47:42+00:00","versionOfRecord":{"articleIdentity":"rs-5769838","link":"https://doi.org/10.1007/s11695-025-07761-4","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2025-03-04 15:58:30","publishedOnDateReadable":"March 4th, 2025"},"versionCreatedAt":"2025-01-11 19:01:34","video":"","vorDoi":"10.1007/s11695-025-07761-4","vorDoiUrl":"https://doi.org/10.1007/s11695-025-07761-4","workflowStages":[]},"version":"v1","identity":"rs-5769838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5769838","identity":"rs-5769838","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}