Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures

Abstract

Background Weight regain after Roux-en-Y gastric bypass (RYGB) is common. Endoscopic sclerotherapy is increasingly used for treatment of this weight regain. Objectives To report safety, outcomes, durability, and predictors of response to sclerotherapy from a large prospective cohort. Design Retrospective analysis of prospective cohort study of patients with weight regain after RYGB. Patients 231 consecutive patients undergoing 575 sclerotherapy procedures between September 2008 – March 2011. Interventions Single or multiple sclerotherapy procedures to inject sodium morrhuate into the rim of the gastrojejunal anastomosis. Main outcome measurements We report weight loss, complications, and predictors of response. We also used Kaplan-Meir survival analysis and log-rank test to compare time to continuation of weight regain after sclerotherapy between patients undergoing a single vs. multiple sclerotherapy procedures. Results At 6 and 12 months from last sclerotherapy procedure weight regain stabilized in 92% and 78% of the cohort, respectively. Those who underwent 2 or 3 sclerotherapy sessions had significantly higher rates of weight regain stabilization than those who underwent a single session (90% vs. 60% at 12 months) (p= 0.003). The average weight loss at 6 months from last sclerotherapy session for the entire cohort was (10 lb, SD 16) representing 18% of the weight regained after RYGB. A subset of 73 patients (32% of the cohort) had higher weight loss at 6 months (26 lb, SD 12) representing 61% of the weight regained. Predictors of favorable outcome included higher magnitude of weight regain and number of sclerotherapy procedures. Bleeding was reported in 2.4% of procedures and transient diastolic blood pressure elevations in 15%, without adverse health outcomes. No gastrointestinal perforations were reported. Conclusions Endoscopic sclerotherapy appears to be a safe and effective tool for the management of weight regain after RYGB.

Argon Plasma Coagulation of Gastrojejunal Anastomosis for Weight Regain After Gastric Bypass

“…In the 32 % of individuals who underwent two or three sessions of sclerotherapy, the percentage loss of weight regained was as much as 61 % [22]. In 116 patients with weight regain after gastric bypass who underwent the ROSE® (Restorative Obesity Surgery, Endoluminal -USGI) endoscopic procedure, a reduction of 32 % of regained weight was observed 6 months after the procedure [23].…”

Retrospective analysis of the effects of continuous intraluminal aspiration on postoperative intestinal fistulas

“…Invasive methods are commonly used to treat fistulas and complications due to anastomotic leakage that develop after surgery for many benign and malignant GI diseases, which previously had only one treatment [5][6][7][8][9][10][11][12]. Because of the high morbidity and mortality of patients with a fistula and/or anastomotic leakage, the search for treatments has continued due to the lack of a demonstrably effective method.…”

“…Stents or clips, band ligation, and injection of tissue adhesive agents have become popular methods to treat fistulas and an anastomotic leakage [5][6][7][8][9][10][11][12]. Several methods of nonsurgical fistula closure have been attempted but none has been proved in a randomized, prospective trial.…”

“…Today, surgery is still used, but less frequently due to developments in endoscopic technology and assistant's tools. The success of treatments methods that are less invasive and easier than surgery has increased, and reduced complications from these methods have decreased the requirement for surgery remarkably in recent years [5][6][7][8][9][10][11][12]. In this study, we share our experience of patients who received continuous intraluminal aspiration to treat a fistula and anastomotic leakage.…”

Endoscopic management of bariatric surgical complications

“…Several endoscopic techniques have been used to reduce the size of the gastrojejunal anastomosis (target between 8 and 10 mm) including sclerotherapy, APC, OTSC, and endoscopic suturing systems. Sclerotherapy involves injecting sodium morrhuate (10-30 ml) around the dilated anastomotic site to facilitate scarring resulting in aperture reduction and compliance [63][64][65]. It is ineffective for anastomosis more than 30 mm in diameter [65].…”