Argon plasma coagulation alone versus endoscopic suturing plus argon plasma coagulation to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos)

Vitor Ottoboni Brunaldi, Galileu Ferreira Ayala Farias, Daniel Tavares de Rezende, Gabriel Cairo-Nunes, Daniel Riccioppo, Diogo Turiani Hourneaux de Moura, Marco Aurelio Santo, Eduardo Guimarães Hourneaux de Moura
Gastrointestinal Endoscopy 2020 March 23

BACKGROUND AND AIMS: A significant portion of patients regain weight after Roux-en-Y gastric bypass (RYGB). Both ablation with argon plasma coagulation (APC) plus endoscopic full-thickness suturing (FTS-APC) and ablation alone have been reported at treating weight regain when associated with gastrojejunostomy (GJ) dilation. However, comparative controlled data are still lacking.

METHODS: This was a pilot single-center open-label randomized trial comparing the effectiveness and safety of APC alone versus FTS-APC in performing transoral outlet reduction. Patients with at least 20% weight regain from the nadir, and GJ ≥15 mm were considered eligible. The primary outcome was % total weight loss (%TWL) at 12 months. Secondary outcomes were the incidence of adverse events, amelioration of metabolic laboratory parameters, and improvement in quality of life (QOL) and eating behavior.

RESULTS: Forty patients meeting eligibility criteria were enrolled from October 2017 to July 2018. Technical and clinical success rates were similar between groups. At 12 months, the mean %TWL was 8.3 ± 5.5 in the APC alone group versus 7.5 ± 7.7% in the FTS-APC group (p=0.71). The prerevisional % solid gastric retention at 1 hour positively correlated with the probability of achieving ≥10% TWL at 12 months. Both groups experienced significant reductions in LDL and triglycerides levels at 12 months, and improvement in eating behavior and QOL at 3 months. There were 2 cases of stenoses (one from each group) successfully treated with endoscopic balloon dilation.

CONCLUSION: The APC alone is similar to the FTS-APC in terms of technical and clinical outcomes within 1 year of follow-up.

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