Endoscopic Management of Weight Recurrence Following Bariatric Surgery

Abstract

Metabolic and bariatric surgery is the most effective therapy for weight loss and improving obesity-related comorbidities, comprising the Roux-en-Y gastric bypass (RYGB), gastric banding, sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch. While the effectiveness of weight loss surgery is well-rooted in existing literature, weight recurrence (WR) following bariatric surgery is a concern. Endoscopic bariatric therapy presents an anatomy-preserving and minimally invasive option for managing WR in select cases. In this review article, we will highlight the endoscopic management techniques for WR for the most commonly performed bariatric surgeries in the United States –RYGB and SG. For each endoscopic technique, we will review weight loss outcomes in the short and mid-terms and discuss safety and known adverse events. While there are multiple endoscopic options to help address anatomical issues, patients should be managed in a multidisciplinary approach to address anatomical, nutritional, psychological, and social factors contributing to WR.

Bariatric endoscopy: from managing complications to primary metabolic procedures

“…Eating habits and psychosocial factors are not the only reasons people regain weight. Surgically modifiable risk factors, including larger gastrojejunal stoma diameter and post-sleeve gastrectomy gastric volumes, have statistically significant correlations with increased weight recurrence [30,[34][35][36]. Traditionally, patients could undergo corrective or conversion operations to address these anatomic factors, but revisional surgeries carry a higher risk of morbidity than primary bariatric surgery [37].…”

Cirurgia bariátrica - aspectos epidemiológicos, fisiopatológicos e principais técnicas cirúrgicas empregadas

“…De acordo com FINK et al, (2022) um aumento no IMC de 5 Kg/m2 aumenta em 29% a taxa de mortalidade e indivíduos com IMC entre 40 a 45 Kg/m2 têm uma redução na expectativa de vida de oito a dez anos. Outrossim, o acúmulo de gorduras gerado pela obesidade leva a diversos complicações, como doenças cardiovasculares, neurodegenerativas, osteoarticulares, doença do refluxo gastroesofágico, DM, NASH, carcinoma hepatocelular, adenocarcinoma gástrico, doença diverticular e câncer pancreático (FRIGOLET et al, 2020;VALENTÍ et al, 2020;DELEDDA et al, 2021;ABBOUD et al, 2022;WEI;LI;ZHANG, 2022).…”

“…Ademais, durante muito tempo foi o procedimento cirúrgico mais utilizado para tratamento de obesidade, até o advento da gastrectomia vertical (SLEEVE), que evidenciou similar perda ponderal e menos efeitos colaterais, sendo o mais utilizado atualmente. Mesmo com essa mudança de preferência , o bypass continua sendo o segundo procedimento mais utilizado e, atualmente, configura uma alternativa para pacientes submetidos a gastrectomia vertical que apresentam novos aumentos de peso ou refluxo (FRIGOLET et al, 2020;ABBOUD et al, 2022;WEI;LI;ZHANG, 2022).…”

“…O aumento significativo na demanda por esse tipo de procedimento em todo o mundo reflete o reconhecimento dos benefícios alcançados, como a perda de peso sustentável, a melhora das comorbidades metabólicas e o aumento da expectativa de vida dos pacientes obesos (BETTINI et al, 2020;AKALESTOU et al, 2021;JABBOUR;SALMAN, 2021;ABBOUD et al, 2022;STENBERG et al, 2022).…”

Endoscopic Transoral Outlet Reduction (TORe) for weight re-gain (WR) in patients after One Anastomosis Gastric Bypass (OAGB) – Case Series

“…After diagnostic gastroscopy excluded any contra-indications TORe was carried out under general anasthesia using circumferential argon plasma coagulation and a suture pattern that created an elongated narrowing of the anastomosis to <10mm (Tubular TORe). All patients were followed prospectively after giving informed concent prior to the procedure 1 2 3 4 5 6 7 8 9 10 11 12.…”