Roux-en-Y gastric bypass pouch outlet reduction using argon plasma coagulation to treat weight regain: a randomized controlled trial with a sham control group

Abstract

Background and study aims A comparative study was conducted to evaluate the efficacy of argon plasma coagulation (APC) therapy in treating post Roux-en-Y gastric bypass (RYGB) weight regain and the incidence of complications related to this procedure, using a sham treatment group as a control.

Patients and methods Forty-one patients with a minimum weight regain of 10 kg and a minimum postoperative time of 36 months were randomized into two groups.

Results In the APC group (n = 21), the mean initial weight was 100.4 kg and the mean weight regain was 24.94 kg. In the sham group (n = 20), the mean initial weight was 103.65 kg, and the mean weight regain was 25.18 kg. Anastomotic stenosis occurred only after the first APC session. The results for the comparison of APC with the sham group showed a percentage weight regain loss of 63.95 compared to -.65, and weight loss of 15.02 and –0.57), percentage total weight loss of 14.46 and –0.62, excess weight loss of 54.32 % and –2.34 %), and BMI reduction of 5.38 and –0.21, with P < 0.0001 for all the comparisons. In the APC group, there was a significant reduction in HbA1c (5.66 % to 4.96 %) and triglycerides (153.20 mg/dL to 132.20 mg/dL).

Conclusions This study indicates that APC outlet pouch reduction outperforms sham treatment in terms of weight loss for patients presenting weight regain after RYGB.

Publication History

Received: 31 October 2022

Accepted after revision: 30 January 2023

Accepted Manuscript online:
06 February 2023

Article published online:
28 April 2023

• References

• 1 World Health Organization. https://www.sbcbm.org.br/endoscopia-e-obesidade/
• 2 IBGE- Instituto Brasileiro de Geografia e Estatística. http://www.ibge.gov.br
• 3 Almby K, Edholm D. Anastomotic strictures after Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry. Obes Surg 2019; 29: 172-177
• 4 Keren D, Rainis T. Intragastric balloons for overweight populations-1 year post removal. Obes Surg 2018; 28: 2368-2373
• 5 Falcão de Santana M, Menezes Marques L, Lopes Gibara V. et al. Ectopic spleen mimicking hepatocellular carcinoma in the late post-operative period of bariatric surgery. Cell Mol Biol (Noisy-le-grand) 2018; 64: 113-115
• 6 Docimo Jr S, Svestka M. Endoscopic evaluation and treatment of postoperative bariatric surgery complications. Surg Innov 2017; 24: 616-624
• 7 Schlosser T, Feisthammel J, Moessner J. et al. Endoscopic treatment of obesity and complications after bariatric surgery. Minerva Chir 2017; 72: 530-537
• 8 Schulman AR, Thompson CC. Complications of bariatric surgery: what you can expect to see in your GI practice. Am J Gastroenterol 2017; 112: 1640-1655
• 9 Montoya-Ramírez J, Aguilar-Espinosa F, Gutiérrez-Salinas J. et al. Robot-assisted surgery and endoscopic management of gastrocolic fistula: A rare complication of acute pancreatitis in a patient who had undergone sleeve gastrectomy. Asian J Endosc Surg 2019; 12: 465-468
• 10 Turcu F, Balahura C, Doras I. et al. Symptomatic stenosis after laparoscopic sleeve gastrectomy - incidence and management in a high-volume bariatric surgery center. Chirurgia (Bucur) 2018; 113: 826-836
• 11 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
• 12 de Quadros LG, Neto MG, Marchesini JC. et al. Endoscopic argon plasma coagulation vs. multidisciplinary evaluation in the management of weight regain after gastric bypass surgery: a randomized controlled trial with sham group. Obes Surg 2020; 30: 1904-1916
• 13 De Moura DTH, Sachdev AH, Lu PW. et al. Acute bleeding after argon plasma coagulation for weight regain after gastric bypass: A case report. World J Clin Cases 2019; 7: 2038-2043
• 14 Brunaldi VO, Farias GFA, de Rezende DT. et al. Argon plasma coagulation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos). Gastrointest Endosc 2020; 92: 97-107.e5
• 15 Jirapinyo P, de Moura DTH, Dong WY. et al. Dose response for argon plasma coagulation in the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointest Endosc 2020; 91: 1078-1084
• 16 Nguyen D, Dip F, Huaco JA. et al. Outcomes of revisional treatment modalities in non-complicated Roux-en-Y gastric bypass patients with weight regain. Obes Surg 2015; 25: 928-934
• 17 Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol 2013; 9: 13-27
• 18 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
• 19 Cambi MP, Marchesini SD, Baretta GA. Post-bariatric surgery weight regain: evaluation of nutritional profile of candidate patients for endoscopic argon plasma coagulation. Arq Bras Cir Dig 2015; 28: 40-43
• 20 CONSORT; 2023 http://www.consort-statement.org
• 21 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
• 22 De Souza LM, de Quadros LG, Kaiser 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
• 23 Minitab Quality Analysis. https://www.minitab.com
• 24 Moberly JG, Bernards MT, Waynant KV. Key features and updates for origin 2018. J Cheminform 2018; 10: 5
• 25 Schulman A, Abidi WM, Thompson CC. Plication versus argon plasma coagulation in the treatment of weight regain after gastric bypass: a matched controlled cohort study. Obes Surg 2013; 30: 1904-1916
• 26 Heneghan HM, Yimcharoen P, Brethauer SA. et al. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis 2012; 8: 408-415
• 27 Abu Dayyeh BK, Acosta A, Camilleri M. et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol 2017; 1: P37-P43.e1
• 28 Ramos AC, Marchesini JC, de Souza Bastos EL. et al. The role of gastrojejunostomy size on gastric bypass weight loss. Obes Surg 2017; 27: 2317-2323
• 29 Galvao Neto M, Marins Campos J. Therapeutic flexible endoscopy after bariatric surgery: a solution for complex clinical scenarios. Cir Esp 2015; 93: 1-3
• 30 Schulman A, Chan WW, Thompson CC. Endoscopic suturing for failed gastric by-pass: predictors of success. AGA. 2013, abstracts S-827 Mo1958
• 31 Jirapinyo P, Slattery J, Ryan MB. et al. Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Endoscopy 2013; 45: 532-536
• 32 Jirapinyo P, Kröner PT, Thompson CC. Purse-string transoral outlet reduction (TORe) is effective at inducing weight loss and improvement in metabolic comorbidities after Roux-en-Y gastric bypass. Endoscopy 2018; 50: 371-377
• 33 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