Dose response for argon plasma coagulation in the treatment of weight regain after Roux-en-Y gastric bypass

Abstract

Background and Aims: Argon plasma coagulation (APC) of gastrojejunal anastomosis (GJA) is effective in treating weight regain after Roux-en-Y gastric bypass (RYGB). This study aims to compare the efficacy of different APC settings for treating weight regain.Methods: This was a single-center retrospective study of patients who had undergone RYGB and then underwent APC from 2014 to 2018 for weight regain. Patients receiving only low-dose APC (45-55 W) or high-dose APC (70-80 W) were compared. The primary outcome was the difference in percentage total weight loss (% TWL) between the groups at 6 and 12 months after the last treatment. Secondary outcomes were technical success, adverse events (AEs), and predictors of weight loss at 12 months.Results: Two hundred seventeen patients met the inclusion criteria and underwent 411 APC sessions. Of these, 116 (53.5%) patients underwent 267 low-dose APC sessions (2.4 AE 1.5 sessions/patient) and 101 (46.5%) patients underwent 144 high-dose APC sessions (1.4 AE 0.7 sessions/patient). Follow-up rates were 82.9% and 75.3% at 6 and 12 months. At 6 months, the low-and high-dose groups experienced 7.3% AE 6.6% and 8.1% AE 7.4% TWL, respectively (P Z .41). At 12 months, the low-and high-dose groups experienced 5.1% AE 8.5% and 9.7% AE 10.0% TWL, respectively (P Z .008). Technical success was 100%. The overall AE rate was 8.0%; the most common AE was GJA stenosis (4.6%). The GJA stenosis rate was similar for the low-and high-dose groups (3.0% vs 7.6%, P Z .06). High-dose APC remained a significant predictor of greater weight loss at 1 year after controlling for confounders. Conclusion:APC is effective at treating weight regain after RYGB, and higher-watt APC was associated with greater weight loss.

Endoscopic Management of Weight Regain in the Bariatric Patient

“…22 Similarly, a more recent single-center study including 217 patients with pretreatment mean GJA diameter of 18.7 mm achieved 9.7% TWL at 12 months. 19 While the use of APC for GJA size reduction is a well-tolerated and safe method, complications have been reported in 5.4 to 8% of cases. 19,22 The most common adverse event is GJA stenosis, which can occur in up to 4.6% of cases, followed by gastrointestinal bleeding, GJ ulceration, superficial coagulation of roux limb, and esophagitis.…”

“…19 While the use of APC for GJA size reduction is a well-tolerated and safe method, complications have been reported in 5.4 to 8% of cases. 19,22 The most common adverse event is GJA stenosis, which can occur in up to 4.6% of cases, followed by gastrointestinal bleeding, GJ ulceration, superficial coagulation of roux limb, and esophagitis. 19,22 Owing to the short procedure duration and safe adverse event profile, APC remains a popular method to treat dilated GJA.…”

“…This method has demonstrated durability and effectiveness in terms of total weight loss (TWL); however, it may be limited with larger GJA diameters (>18 mm). 21 APC can be performed safely under conscious sedation 19 ; however, anesthesia assistance may be required for higher risk patients or those with a history of problems with sedation.…”

“…19,22 The most common adverse event is GJA stenosis, which can occur in up to 4.6% of cases, followed by gastrointestinal bleeding, GJ ulceration, superficial coagulation of roux limb, and esophagitis. 19,22 Owing to the short procedure duration and safe adverse event profile, APC remains a popular method to treat dilated GJA. Potential drawbacks include reduced efficacy with larger GJA diameters, commonly leading to the need for multiple treatments to attain the desired effect.…”

“…12 Endoscopic gastric bypass revision (EGBR) has been described using a variety of techniques to reduce the size of the GJA diameter to 10 to 15 mm to arrest weight regain and facilitate weight loss. 18,19 A comprehensive review of these approaches is summarized later, stratified by nonsuturing and suturing methods.…”