A5117 DOUBLE BALLOON ENTEROSCOPY REDUCES RE- OPERATION RATE AND MORBIDITY IN SELECTED CASES OF SMALL BOWEL OBSTRUCTION AFTER ROUX-EN-Y GASTRIC BYPASS Jacob Juta, MD; Rami El-Abiad, MD; Isaac Samuel, MD; Iowa City, IA, USA Double balloon enteroscopy is a novel technique available only in few centers but is a powerful modality useful to treat selected obstructive complications of Roux-en-Y gastric bypass. We present a case series where double balloon enteroscopy prevented emergent re-operation and therefore minimized the morbidity of small bowel obstruction. 1. A middle aged male underwent a laparoscopic RYGB and on the first postoperative day developed abdominal pain followed by bilious drainage from his JP drain. CT scan of the abdomen showed evidence of hemorrhage into the bypassed stomach and obstruction at the jejuno- jenunostomy and pylorus by large clots, and a small and contained staple line dehiscence of the bypassed stomach. The JP drain along with antibiotics controlled the staple line dehiscence. Double balloon enteroscopy was used to dislodge the clots from the jejuno-jenunostomy and the pylorus and also confirmed that there was no active bleeding. Patient was discharged on a full liquid diet and the JP drain was removed 3 weeks later, while re- operation was entirely avoided. 2. A middle aged male presented with small bowel obstruction a few years after laparoscopic Roux-en- Y gastric bypass, with CT scan showing a cut off at the level of the jejuno-jenunostomy associated with acute dilatation of the bypassed stomach and bilio- pancreatic limb. We treated the small bowel obstruc- tion with percutaneous insertion of a pigtail catheter into the bypassed stomach (by Interventional Radi- ology) to decompress the bilio-pancreatic segment. This was followed by double balloon enteroscopy to dilate the jejuno-jenunostomy. Patient was discharged home tolerating a full liquid diet and the pigtail drain was removed a few weeks later, after a contrast study confirmed the jejuno-jenunostomy was patent. Emer- gent re-operation in the presence of dilated and edematous bowel was therefore avoided. 3. A middle aged female with previous open Roux-en-Y gastric bypass and ventral hernia repair with a large mesh came with small bowel obstruction where CT scan showed a kink in the deep pelvis with common channel and biliopancreatic limb dilatation. Percuta- neous pigtail catheter into the bypassed stomach decompressed the small bowel obstruction and Double balloon enteroscopy from below and above rectified the kink, allowing discharge home tolerating bariatric diet. In this case a complex open reoperation in the presence of a mesh was completely avoided. Double balloon enteroscopy uses two balloons to curtain the small bowel into a shorter length to allow the endoscope to reach extreme distances within the bowel lumen to treat clinical conditions. Its use in the treatment of small bowel obstruction after Roux-en-Y gastric bypass in bariatric surgery is limited. We present three cases where double balloon enteroscopy prevented the need for emergent re- operation and therefore limited the morbidity. We conclude that in selected cases double balloon enteroscopy, some- times in conjunction with percutaneous drainage of the bypassed stomach by interventional radiology, can be employed to relieve small bowel obstruction and therefore prevent the need for re-operation. At a time when clinical program accreditation, quality improvement, and cost of healthcare take into count re-operation rates, novel methods to reduce the need for re-operation are valuable especially if they also benefit the patient with reduced morbidity and risk. A5118 ENDOBARRIER AS A PRE BARIATRIC SURGICAL INTERVENTION IN HIGH RISK PATIENTS Hafsa Younus, MBBS; Saurav Chakravartty; Ameet Patel; King's College Hospital London, London, UK Background: Obesity surgery mortality risk scoring system (OMRS) classifies patients into high, intermediate and low risk; based on age, body mass index, sex and other co morbidities such as hypertension and history of pulmonary embolism. High risk patients not only have a higher mortality, but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopi- cally placed duodenal-jejunal bypass sleeve (EndoBarrier Gastro- intestinal Liner) has been designed to achieve weight loss in morbidly obese patients with clinically proven effectiveness. The aim of this study was to assess if pre-operative endobarrier insertion decreases morbidity and length of stay after bariatric surgery. Methods: Between 2012- 2014, a cohort of 7 high risk patients had an EndoBarrier inserted (ENB Group) for one year prior to definitive bariatric surgery. These patients were matched with a group undergoing primary bariatric surgery (PBS). The two groups were matched for age, sex, body mass index, comorbities, surgical procedure and OMRS. Outcome measures included operative time, morbidity, length of stay, ITU stay, readmission rate and percen- tage excess weight loss. Results: Patient characteristics were similar in both ENB Group and PBS Groups; age (median 46 vs. 46), BMI (median 64 vs. 56 kg/m 2 ), co morbidities (medians 4 vs. 3), OMRS (median 4 vs. 4). There was no significant difference in operative time, ITU stay, readmission rate, and percentage excess weight loss. Median hospital stay was significantly less in ENB group (4 days, range 3-10 days, vs. 7days, range 4-38days, po0.05). Post- operative complications were significantly less in ENB group (0/7, BS group¼5/7,po0.05) Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211 S117