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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(01): E43-E51
DOI: 10.1055/a-1971-6417
Original article

Efficacy of the argon plasma coagulation in patients with weight regain after gastric bypass: a randomized control trial

Gustavo Carvalho Gurian
1   Hospital de Base de São José do Rio Preto – Department of Endoscopy – São José do Rio Preto – SP – Brazil
,
Lígia Moriguchi Watanabe
2   Ribeirao Preto Medical School – Department of Health Sciences – University of São Paulo – Brazil
,
Carla Barbosa Nonino
2   Ribeirao Preto Medical School – Department of Health Sciences – University of São Paulo – Brazil
,
Mariana Barato
3   Sao José do Rio Preto Medical School – Department of Molecular Biology – São José do Rio Preto – SP – Brazil
,
Maysa Araújo Ferreira-Julio
3   Sao José do Rio Preto Medical School – Department of Molecular Biology – São José do Rio Preto – SP – Brazil
,
Francisco Alves Arantes
1   Hospital de Base de São José do Rio Preto – Department of Endoscopy – São José do Rio Preto – SP – Brazil
,
Thiago Sivieri
4   Sao José do Rio Preto Medical School – Department of Metabolic and Bariatric Surgery – São José do Rio Preto – SP – Brazil
,
Natália Yumi Noronha
2   Ribeirao Preto Medical School – Department of Health Sciences – University of São Paulo – Brazil
,
Dorotéia Silva Rossi Souza
3   Sao José do Rio Preto Medical School – Department of Molecular Biology – São José do Rio Preto – SP – Brazil
,
Rafael Fernandes-Ferreira
3   Sao José do Rio Preto Medical School – Department of Molecular Biology – São José do Rio Preto – SP – Brazil
,
Marcela Augusta de Souza Pinhel
2   Ribeirao Preto Medical School – Department of Health Sciences – University of São Paulo – Brazil
› Author Affiliations TRIAL REGISTRATION: Longitudinal, Randomized and Blinded study The Universal Trial Number – UTN: U1111-1259-6021 at Brazilian Clinical Trials Registry (http://www.ensaiosclinicos.gov.br/)
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Abstract

Background and study aims Endoscopic procedure using argon plasma coagulation (APC) promotes a progressive reduction in gastrojejunal anastomosis diameter. The present study aimed to evaluate the efficacy of the APC in patients with weight regain in the postoperative periods of gastric bypass.

Patients and methods This was a randomized controlled trial conducted with 66 patients who were randomly assigned selected (using lottery method) and divided into two groups: study group (SG), 38 patients (APC treatment); and control group (CG), 28 patients (only endoscopy procedure). We considered 30 days,180 days, and one year as short-term, medium-term, and long-term, respectively. The parameters analyzed were total weight loss (TWL), excess weight loss (%EWL), total weight loss (%TWL), and reduction of weight regain (%RWR). Furthermore, a biopsy for neoplastic histological changes was carried out for the APC group. For statistical analysis, values of P < 0.05 were considered significant.

Results The %TWL and %RWR were higher in the SG in short, medium, and long terms, when compared to the same periods in the CG (P < 0.001). One year after follow-up, the final weight did not reach the statistical difference between groups. Biopsy performed in SG 1 year after APC did not reveal neoplastic histological changes.

Conclusions APC effectively treats weight regain after bariatric surgery in the short and medium-term. An important "new" weight gain was observed in the long-term, showing that obesity is a chronic disease that requires multidisciplinary and family care for life. Also, APC is a safe procedure with low adverse event rates.

Supplementary material



Publication History

Received: 15 February 2022

Accepted after revision: 25 October 2022

Article published online:
13 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2023; 55(03): 299-299
DOI: 10.1055/a-1998-4829

 

  • References

  • 1 Sjöström L, Narbro K, Sjöström CD. et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741-752
    CrossrefPubMedGoogle Scholar
  • 2 Puzziferri N, Roshek 3rd TB, Mayo HG. et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA 2014; 312: 934-942
    CrossrefPubMedGoogle Scholar
  • 3 Magro DO, Geloneze B, Delfini R. et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg 2008; 18: 648-651
    CrossrefPubMedGoogle Scholar
  • 4 Spaulding L, Osler T, Patlak J. Long-term results of sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Obes Relat Dis 2007; 3: 623-626
    CrossrefPubMedGoogle Scholar
  • 5 Thompson CC, Slattery J, Bundga ME. et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc 2006; 20: 1744-1748
    CrossrefPubMedGoogle Scholar
  • 6 Mikami D, Needleman B, Narula V. et al. Natural orifice surgery: initial US experience utilizing the StomaphyX device to reduce gastric pouches after Roux-en-Y gastric bypass. Surg Endosc 2010; 24: 223-228
    CrossrefPubMedGoogle Scholar
  • 7 Thompson CC, Jacobsen GR, Schroder GL. et al. Stoma size critical to 12-month outcomes in endoscopic suturing for gastric bypass repair. Surg Obes Relat Dis 2012; 8: 282-287
    CrossrefPubMedGoogle Scholar
  • 8 Galvão Neto M, Rodriguez L, Zundel N. et al. Endoscopic revision of Roux-en-Y gastric bypass stomal dilation with a suturing device: preliminary results of a first out-of-United States series. Bariatric Times 2011; 8: 1-34
    PubMedGoogle Scholar
  • 9 Heylen AM, Jacobs A, Lybeer M. et al. The OTSC(R)-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery. Obes Surg 2011; 21: 1629-1633
    CrossrefPubMedGoogle Scholar
  • 10 Aly A. Argon plasma coagulation and gastric bypass–a novel solution to stomal dilation. Obes Surg 2009; 19: 788-790
    CrossrefPubMedGoogle Scholar
  • 11 Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 1994; 2: 42-46
    PubMedGoogle Scholar
  • 12 Baretta GA, Alhinho HC, Matias JE. et al. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass. Obes Surg 2015; 25: 72-79
    CrossrefPubMedGoogle Scholar
  • 13 Itani MI, Farha J, Sartoretto A. et al. Endoscopic sleeve gastroplasty with argon plasma coagulation: A novel technique. J Dig Dis 2020; 21: 664-667
    CrossrefPubMedGoogle Scholar
  • 14 Brunaldi VO, Jirapinyo P, de Moura DTH. et al. endoscopic treatment of weight regain following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg 2018; 28: 266-276
    CrossrefPubMedGoogle Scholar
  • 15 Conselho Federal de Medicina. Parecer CFM nº 39/16. Plasma de argônio para tratamento do reganho de peso pós cirurgia bariátrica. 2016 https://sistemas.cfm.org.br/normas/arquivos/pareceres/BR/2016/39_2016.pdf
    PubMedGoogle Scholar
  • 16 Abu Dayyeh BK, Jirapinyo P, Weitzner Z. et al. Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures. Gastrointest Endosc 2012; 76: 275-282
    CrossrefPubMedGoogle Scholar
  • 17 Flanagan L. Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg 1996; 6: 38-43
    CrossrefPubMedGoogle Scholar
  • 18 Müller MK, Wildi S, Scholz T. et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg 2005; 15: 1089-1095
    CrossrefPubMedGoogle Scholar
  • 19 De Souza LM, de Quadros LG, Kaiser Junior RL. et al. Argon plasma effect about anastomosis was significant to inhibit the weight regained in patients undergoing gastric bypass. J Obes Weight Loss Ther 2015; 5: 264
    CrossrefPubMedGoogle Scholar
  • 20 Moon RC, Teixeira AF, Neto MG. et al. Efficacy of utilizing argon plasma coagulation for weight regain in Roux-en-Y Gastric bypass patients: a multi-center study. Obes Surg 2018; 28: 2737-2744
    CrossrefPubMedGoogle Scholar
  • 21 Grover BT, Morell MC, Kothari SN. et al. Defining weight loss after bariatric surgery: a call for standardization. Obes Surg 2019; 29: 3493-3499
    CrossrefPubMedGoogle Scholar
  • 22 Marchesini SD, Baretta GA, Cambi MP. et al. Endoscopic plasma argon coagulation in the treatment of weight regain after bariatric surgery: what does the patient think about this?. Arq Bras Cir Dig 2014; 27: 47-50
    CrossrefPubMedGoogle Scholar
  • 23 Zingg U, McQuinn A, DiValentino D. et al. Revisional vs. primary Roux-en-Y gastric bypass--a case-matched analysis: less weight loss in revisions. Obes Surg 2010; 20: 1627-1632
    CrossrefPubMedGoogle Scholar
  • 24 Baker RS, Foote J, Kemmeter P. et al. The science of stapling and leaks. Obes Surg 2004; 14: 1290-1298
    CrossrefPubMedGoogle Scholar
  • 25 Dotti VP, Baretta GAP, Yoshii SO. et al. Termocoagulação endoscópica do esôfago de Barrett com plasma de argônio sob diferentes potências: análise histopatológica e de sintomas pós-procedimento. Rev Col Bras Cir 2009; 36: 110-117
    CrossrefPubMedGoogle Scholar
  • 26 Garrido T, Maluf-Filho F, Baba ER. et al. Análise histopatológica do efeito da eletrocoagulação bipolar e da aplicação de plasma de argônio em espécimes cirúrgicos do trato digestório. ABCD: Arquivos Brasileiros de Cirurgia Digestiva 2002; 15: 116-120
    PubMedGoogle Scholar
  • 27 Lopez-Nava G, Galvão MP, Bautista-Castaño I. et al. Endoscopic sleeve gastroplasty with 1 year follow-up: predictive factors of success. Endosc Int Open 2016; 4: E222-E227
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Lopez-Nava G, Asokkumar R, Rull A. et al. Bariatric endoscopy procedure type or follow-up: What predicted success at 1 year in 962 obese patients?. Endosc Int Open 2019; 7: E1691-E1698
    Article in Thieme ConnectPubMedGoogle Scholar