Digestive Disease Interventions 2021; 05(02): 162-168
DOI: 10.1055/s-0041-1728656
Special Communication

Endoscopic Management of Weight Regain in the Bariatric Patient

Russell D. Dolan
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts
,
Allison R. Schulman
2   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
› Author Affiliations

Abstract

Despite initial weight loss following bariatric surgery, weight recidivism is common. While weight regain is multifactorial and includes behavioral, psychosocial, and medical causes, changes in anatomy also play a role. Dilation of the gastrojejunal anastomosis following Roux-en-Y gastric bypass and enlargement of the gastric sleeve following sleeve gastrectomy are both important considerations. Historically, surgical revision has been performed to address weight regain; however, morbidity and mortality are not insignificant. Over the past decade, a variety of endoscopic approaches have been described for weight recidivism, several of which have proven to be safe, effective, and durable. This article will review each of these techniques in detail.

Guarantor of the Article

Allison R. Schulman, MD, MPH.


Authors' Contributions

R.D.D.: drafting of the manuscript; critical revision of the manuscript for important intellectual content; approving of the final draft submitted (email rddolan@bwh.harvard.edu).


A.R.S.: critical revision of the manuscript for important intellectual content; approving of the final draft submitted (email arschulm@med.umich.edu).


Financial Support/Potential Competing Interests

A.R.S.—Apollo Endosurgery (consultant); Boston Scientific (consultant); MicroTech (consultant); GI Dynamics (research, grant support. R.D.D. has no personal or financial conflicts of interest to disclose).




Publication History

Received: 11 September 2020

Accepted: 02 March 2021

Article published online:
15 April 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Salminen P, Helmiö M, Ovaska J. et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA 2018; 319 (03) 241-254
  • 2 Peterli R, Wölnerhanssen BK, Peters T. et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 2018; 319 (03) 255-265
  • 3 Toolabi K, Sarkardeh M, Vasigh M, Golzarand M, Vezvaei P, Kooshki J. Comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss, weight regain, and remission of comorbidities: a 5 years of follow-up study. Obes Surg 2020; 30 (02) 440-445
  • 4 Adams TD, Davidson LE, Litwin SE. et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 2017; 377 (12) 1143-1155
  • 5 Felsenreich DM, Langer FB, Kefurt R. et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2016; 12 (09) 1655-1662
  • 6 Bastos EC, Barbosa EM, Soriano GM, dos Santos EA, Vasconcelos SM. Determinants of weight regain after bariatric surgery. Arq Bras Cir Dig 2013; 26 (Suppl. 01) 26-32
  • 7 Sjöström L, Narbro K, Sjöström CD. et al; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357 (08) 741-752
  • 8 Monaco-Ferreira DV, Leandro-Merhi VA. Weight regain 10 years after Roux-en-Y gastric bypass. Obes Surg 2017; 27 (05) 1137-1144
  • 9 Perugini RA, Mason R, Czerniach DR. et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003; 138 (05) 541-545 , discussion 545–546
  • 10 Odom J, Zalesin KC, Washington TL. et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg 2010; 20 (03) 349-356
  • 11 van Hout GC, Verschure SK, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg 2005; 15 (04) 552-560
  • 12 Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 2011; 9 (03) 228-233
  • 13 Yao DC, Stellato TA, Schuster MM, Graf KN, Hallowell PT. Gastrogastric fistula following Roux-en-Y bypass is attributed to both surgical technique and experience. Am J Surg 2010; 199 (03) 382-385 , discussion 385–386
  • 14 Cucchi SG, Pories WJ, MacDonald KG, Morgan EJ. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg 1995; 221 (04) 387-391
  • 15 Yu Y, Klem ML, Kalarchian MA, Ji M, Burke LE. Predictors of weight regain after sleeve gastrectomy: an integrative review. Surg Obes Relat Dis 2019; 15 (06) 995-1005
  • 16 Qiu J, Lundberg PW, Javier Birriel T, Claros L, Stoltzfus J, El Chaar M. Revisional bariatric surgery for weight regain and refractory complications in a single MBSAQIP accredited center: What are we dealing with?. Obes Surg 2018; 28 (09) 2789-2795
  • 17 Switzer NJ, Karmali S, Gill RS, Sherman V. Revisional bariatric surgery. Surg Clin North Am 2016; 96 (04) 827-842
  • 18 Patel LY, Lapin B, Brown CS. et al. Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction. Surg Endosc 2017; 31 (06) 2667-2677
  • 19 Jirapinyo P, de Moura DTH, Dong WY, Farias G, Thompson CC. Dose response for argon plasma coagulation in the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointest Endosc 2020; 91 (05) 1078-1084
  • 20 Baretta GA, Alhinho HC, Matias JE. et al. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass. Obes Surg 2015; 25 (01) 72-79
  • 21 Jirapinyo P, Thompson CC. 721 personalized algorithm for the management of weight regain following Roux-en-Y gastric bypass: suturing versus plication versus argon plasma coagulation. Gastrointest Endosc 2020; 91 (06) AB60-AB61
  • 22 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 (09) 2737-2744
  • 23 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 (05) 1904-1916
  • 24 Heylen AM, Jacobs A, Lybeer M, Prosst RL. The OTSC®-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery. Obes Surg 2011; 21 (10) 1629-1633
  • 25 Abrams JA, Komanduri S, Shaheen NJ, Wang Z, Rothstein RI. Radiofrequency ablation for the treatment of weight regain after Roux-en-Y gastric bypass surgery. Gastrointest Endosc 2018; 87 (01) 275-279.e2
  • 26 Parsi MA, Trindade AJ, Bhutani MS. et al; ASGE Technology Committee. Cryotherapy in gastrointestinal endoscopy. VideoGIE 2017; 2 (05) 89-95
  • 27 Fayad L, Trindade AJ, Benias PC. et al. Cryoballoon ablation for gastric pouch and/or outlet reduction in patients with weight regain post Roux-en-Y gastric bypass. Endoscopy 2020; 52 (03) 227-230
  • 28 Catalano MF, Rudic G, Anderson AJ, Chua TY. Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc 2007; 66 (02) 240-245
  • 29 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 (02) 275-282
  • 30 Riva P, Perretta S, Swanstrom L. Weight regain following RYGB can be effectively treated using a combination of endoscopic suturing and sclerotherapy. Surg Endosc 2017; 31 (04) 1891-1895
  • 31 Jirapinyo P, Dayyeh BK, Thompson CC. Gastrojejunal anastomotic reduction for weight regain in Roux-en-Y gastric bypass patients: physiological, behavioral, and anatomical effects of endoscopic suturing and sclerotherapy. Surg Obes Relat Dis 2016; 12 (10) 1810-1816
  • 32 Horgan S, Jacobsen G, Weiss GD. et al. Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis 2010; 6 (03) 290-295
  • 33 Abu Dayyeh BK, Kumar N, Edmundowicz SA. et al; ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc 2015; 82 (03) 425-438.e5
  • 34 Mullady DK, Lautz DB, Thompson CC. Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). Gastrointest Endosc 2009; 70 (03) 440-444
  • 35 Thompson CC, Jacobsen GR, Schroder GL, Horgan S. Stoma size critical to 12-month outcomes in endoscopic suturing for gastric bypass repair. Surg Obes Relat Dis 2012; 8 (03) 282-287
  • 36 Storm AC, Thompson CC. Endoscopic treatments following bariatric surgery. Gastrointest Endosc Clin N Am 2017; 27 (02) 233-244
  • 37 Thompson CC, Chand B, Chen YK. et al. Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology 2013; 145 (01) 129-137.e3
  • 38 Jirapinyo P, Kumar N, AlSamman MA, Thompson CC. Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointest Endosc 2020; 91 (05) 1067-1073
  • 39 Schulman AR, Kumar N, Thompson CC. Transoral outlet reduction: a comparison of purse-string with interrupted stitch technique. Gastrointest Endosc 2018; 87 (05) 1222-1228
  • 40 Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc 2016; 83 (04) 776-779
  • 41 de Moura DTH, Jirapinyo P, Thompson CC. Modified-ESD plus APC and suturing for treatment of weight regain after gastric bypass. Obes Surg 2019; 29 (06) 2001-2002
  • 42 Hollenbach M, Selig L, Lellwitz S. et al. Endoscopic full-thickness transoral outlet reduction with semicircumferential endoscopic submucosal dissection. Endoscopy 2019; 51 (07) 684-688
  • 43 Jirapinyo P, de Moura DTH, Thompson CC. Endoscopic submucosal dissection with suturing for the treatment of weight regain after gastric bypass: outcomes and comparison with traditional transoral outlet reduction (with video). Gastrointest Endosc 2020; 91 (06) 1282-1288
  • 44 English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis 2018; 14 (03) 259-263
  • 45 Clapp B, Wynn M, Martyn C, Foster C, O'Dell M, Tyroch A. Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. Surg Obes Relat Dis 2018; 14 (06) 741-747
  • 46 de Moura DTH, Barrichello Jr S, de Moura EGH. et al. Endoscopic sleeve gastroplasty in the management of weight regain after sleeve gastrectomy. Endoscopy 2020; 52 (03) 202-210
  • 47 Jirapinyo P, de Moura DTH, Thompson CC. Sleeve in sleeve: endoscopic revision for weight regain after sleeve gastrectomy. VideoGIE 2019; 4 (10) 454-457