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Efficacy of Utilizing Argon Plasma Coagulation for Weight Regain in Roux-en-Y Gastric Bypass Patients: a Multi-center Study

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Abstract

Background

Endoscopic approaches exist for targeting weight regain after Roux-en-Y gastric bypass (RYGB), including endoscopic suturing, clipping, and sclerotherapy. Argon plasma coagulation (APC) is a noncontact electrocoagulation method, and when used in RYGB patients, it has shown reduction in the diameter of the gastrojejunal anastomosis.

Objectives

To study the effectiveness of APC for weight regain in terms of weight loss for RYGB patients, from eight bariatric centers.

Methods

A retrospective chart review was performed for 558 patients at eight bariatric centers in the USA (1) and Brazil (7) who underwent APC procedure between 31st July 2009 and 29th March 2017. APC was performed on patients who regained weight after RYGB procedure.

Results

Upon exploratory analysis of the individual BMI data, the mean BMI decreased slightly during the first 24 months and increased slightly afterwards following the APC intervention. The mean weight was 94.5 ± 18.6 kg and the mean BMI was 34.0 kg/m2 at APC. Where data were available, the mean of lowest weight was 67.0 ± 23.0 kg and the mean of lowest BMI was 24.1 kg/m2 following gastric bypass. The mean weight loss was 6.5, 7.7, and 8.3 kg at 6, 12, and 24 months, respectively, and the changes in weight over time was statistically significant (p < 0.0001). Multi-level for change model showed the low body mass index (BMI) group (BMI < 30 kg/m2) to have greater TWL than the high BMI (BMI ≥ 30 kg/m2) group at 6, 12, and 24 months. In the low BMI group, the mean TWL was 4.7, 6.1, 6.9, and 2.4%, at 6, 12, and 24 months, respectively. In the high BMI group, the mean TWL was 7.5, 10.4, 13.4, and 3.7%, at 6, 12, 24, and 36 months, respectively. Of the 333 patients in four centers who provided complication information, complications after APC included stenosis (n = 9), GJ ulcer (n = 3), vomiting (n = 3), GJ leakage (n = 2), and melena (n = 1).

Conclusion

APC can be useful in reducing the regained weight after RYGB, and patients showed 6–10% total weight loss at 12 months. Randomized trials would be needed to validate the findings.

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References

  1. Maciejewski ML, Arterburn DE, van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55.

    Article  Google Scholar 

  2. Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55.

    Article  Google Scholar 

  3. Hawkins RB, Mehaffey JH, McMurry TL, et al. Clinical significance of failure to lose weight 10 years after roux-en-y gastric bypass. Surg Obes Relat Dis. 2017;13(10):1710–6.

    Article  Google Scholar 

  4. Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.

    Article  Google Scholar 

  5. Moon RC, Teixeira AF, Jawad MA. Treatment of weight regain following roux-en-Y gastric bypass: revision of pouch, creation of new gastrojejunostomy and placement of proximal pericardial patch ring. Obes Surg. 2014;24(6):829–34.

    Article  Google Scholar 

  6. Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734–40.

    Article  Google Scholar 

  7. Dakin GF, Eid G, Mikami D, et al. Endoluminal revision of gastric bypass for weight regain--a systematic review. Surg Obes Relat Dis. 2013;9(3):335–42.

    Article  Google Scholar 

  8. Yimcharoen P, Heneghan HM, Singh M, et al. Endoscopic findings and outcomes of revisional procedures for patients with weight recidivism after gastric bypass. Surg Endosc. 2011;25(10):3345–52.

    Article  Google Scholar 

  9. Spaulding L, Osler T, Patlak J. Long-term results of sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Obes Relat Dis. 2007;3(6):623–6.

    Article  Google Scholar 

  10. Jin F, Mu D, Xie Y, et al. Application of bronchoscopic argon plasma coagulation in the treatment of tumorous endobronchial tuberculosis: historical controlled trial. J Thorac Cardiovasc Surg. 2013;145(6):1650–3.

    Article  Google Scholar 

  11. Lee YA, Chun P, Hwang EH, et al. Gastric hemangioma treated with argon plasma coagulation in a newborn infant. Pediatr Gastroenterol Hepatol Nutr. 2017;20(2):134–7.

    Article  Google Scholar 

  12. Kapadia S, Nagula S, Kumta NA. Argon plasma coagulation for successful fragmentation and removal of an over-the-scope clip (OTSC). Dig Endosc. 2017;29:820–1.

    Article  Google Scholar 

  13. Baretta GA et al. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass. Obes Surg. 2015;25(1):72–9.

    Article  Google Scholar 

  14. de Quadros LG, Galvão Neto MP, Campos JM, et al. Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study. BMC Res Notes. 2017;10(1):13.

    Article  Google Scholar 

  15. 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(5):928–34.

    Article  Google Scholar 

  16. Patel S, Szomstein S, Rosenthal RJ. Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding). Obes Surg. 2011;21(8):1209–19.

    Article  Google Scholar 

  17. Muller MK et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15(8):1089–95.

    Article  Google Scholar 

  18. Vijgen GH et al. Salvage banding for failed Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012;8(6):803–8.

    Article  Google Scholar 

  19. Dapri G, Cadiere GB, Himpens J. Laparoscopic conversion of Roux-en-Y gastric bypass to distal gastric bypass for weight regain. J Laparoendosc Adv Surg Tech A. 2011;21(1):19–23.

    Article  Google Scholar 

  20. Rawlins ML, Teel II D, Hedgcorth K, et al. Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. 2011;7(1):45–9.

    Article  Google Scholar 

  21. Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis. 2007;3(6):611–8.

    Article  Google Scholar 

  22. Keshishian A, Zahriya K, Hartoonian T, et al. Duodenal switch is a safe operation for patients who have failed other bariatric operations. Obes Surg. 2004;14(9):1187–92.

    Article  Google Scholar 

  23. Maleckas A, Gudaitytė R, Petereit R, et al. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. 2016;5(6):617–24.

    Article  Google Scholar 

  24. 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(6):2667–77.

    Article  Google Scholar 

  25. Moon RC, Nelson L, Teixeira AF, et al. Outcomes of Roux-en-Y gastric bypass in the super obese: comparison of body mass index 50–60 kg/m(2) and>/=60 kg/m(2) with the morbidly obese. Surg Obes Relat Dis. 2016;12(2):292–6.

    Article  Google Scholar 

  26. Taylor JD, Leitman IM, Hon P, et al. Outcome and complications of gastric bypass in super-super obesity versus morbid obesity. Obes Surg. 2006;16(1):16–8.

    Article  Google Scholar 

  27. Thereaux J, Czernichow S, Corigliano N, et al. Five-year outcomes of gastric bypass for super-super-obesity (BMI>/=60 kg/m(2)): a case matched study. Surg Obes Relat Dis. 2015;11(1):32–7.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 Copeland Dr, 1st Floor, Orlando, FL, USA

    Rena C. Moon, Andre F. Teixeira & Muhammad A. Jawad

  2. Hospital 9 July, Sao Paulo, Brazil

    Manoel Galvao Neto & Artagnan Menezes Barbosa de Amorim

  3. Herbert Wertheim College of Medicine, Miami, FL, USA

    Manoel Galvao Neto & Natan Zundel

  4. Sander Medical Center, Belo Horizonte, Minas Gerais, Brazil

    Bruno Queiroz Sander

  5. Endodiagnostic, Rio de Janeiro, Brazil

    Flavio Mitidieri Ramos & Felipe Matz

  6. Hospital Vita Batel e pos Graduacao da Universidade Positivo, Bigorrilho, Curitiba, Brazil

    Giorgio A. Baretta

  7. ABC Medical School, Santo Andre, Brazil

    Luiz Gustavo de Quadros, Eduardo Grecco, Thiago Souza & Sergio A. Barrichello

  8. Clinica Concon e Hospital e Maternidade Galileo, Valinhos, Brazil

    Admar Concon Filho

  9. Usuy Clinic, Florianopolis, Brazil

    Eduardo Nobuyuki Usuy Jr.

Authors
  1. Rena C. Moon
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  2. Andre F. Teixeira
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  7. Felipe Matz
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  8. Giorgio A. Baretta
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  9. Luiz Gustavo de Quadros
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  10. Eduardo Grecco
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  11. Thiago Souza
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  14. Eduardo Nobuyuki Usuy Jr.
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  15. Artagnan Menezes Barbosa de Amorim
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  16. Muhammad A. Jawad
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Corresponding author

Correspondence to Andre F. Teixeira.

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The authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required.

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Additional information

The abstract of this article has been selected to present at International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2017 Annual Meeting (Aug 29th–Sep 2nd, 2017, London, UK)

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Moon, R.C., Teixeira, A.F., Neto, M.G. et al. Efficacy of Utilizing Argon Plasma Coagulation for Weight Regain in Roux-en-Y Gastric Bypass Patients: a Multi-center Study. OBES SURG 28, 2737–2744 (2018). https://doi.org/10.1007/s11695-018-3229-5

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  • DOI: https://doi.org/10.1007/s11695-018-3229-5

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