Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis

Abstract

Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure. Despite its high efficacy, some patients regain part of their lost weight. Several endoscopic therapies have been introduced as alternatives to treat weight regain, but most of the articles are relatively small with unclear long-term data. To systematically assess the efficacy of endoscopic therapies for weight regain after RYGB. We searched MEDLINE, EMBASE, Scopus, Web of Science, Cochrane, OVID, CINAHL/EBSCo, LILACS/Bireme, and gray literature. Primary outcomes were absolute weight loss (AWL), excess weight loss (EWL), and total body weight loss (TBWL). Thirty-two studies were included in qualitative analysis. Twenty-six described full-thickness (FT) endoscopic suturing and pooled AWL, EWL, and TBWL at 3 months were 8.5 ± 2.9 kg, 21.6 ± 9.3%, and 7.3 ± 2.6%, respectively. At 6 months, they were 8.6 ± 3.5 kg, 23.7 ± 12.3%, and 8.0 ± 3.9%, respectively. At 12 months, they were 7.63 ± 4.3 kg, 16.9 ± 11.1%, and 6.6 ± 5.0%, respectively. Subgroup analysis showed that all outcomes were significantly higher in the group with FT suturing combined with argon plasma coagulation (APC) (p < 0.0001). Meta-analysis included 15 FT studies and showed greater results. Three studies described superficial-thickness suturing with pooled AWL of 3.0 ± 3.8, 4.4 ± 0.07, and 3.7 ± 7.4 kg at 3, 6, and 12 months, respectively. Two articles described APC alone with mean AWL of 15.4 ± 2.0 and 15.4 ± 9.1 kg at 3 and 6 months, respectively. Full-thickness suturing is effective at treating weight regain after RYGB. Performing APC prior to suturing seems to result in greater weight loss. Head-to-head studies are needed to confirm our results. Few studies adequately assess effectiveness of other endoscopic techniques.

Reversal of Long-Term Weight Regain After Roux-en-Y Gastric Bypass Using Liraglutide or Surgical Revision. A Prospective Study

“…Median weight regain from weight NADIR was 25% (range 11-46; Table 1). (b) Endosurgery, using Apollo's Overstitch™ suturing system to reinstall restriction (group ES, n = 15) [12]. Median weight regain from weight NADIR was 20% (range 11-52; Table 1).…”

“…Bariatric surgery is especially prone to late revisions due to insufficient weight loss or weight regain, which results in increased complications and higher mortality rates [6][7][8][9][10][11]. Endosurgery for dilated upper anastomosis and weight regain was evaluated in a 2018 meta-analysis [12] and considered a valid alternative to laparoscopic surgical reoperation for weight regain, as a much lower complication rate was recorded [12] compared with laparoscopic reoperations [6][7][8][9][10][11].…”

“…These patients were assigned to different groups: initiation of liraglutide . [5,[13][14][15], endosurgery of the upper anastomosis [12], or laparoscopic implantation of a Fobi-ring with pouch resizing [11,17]. Patients who kept their weight through lifestyle treatment alone [18] served as control.…”

You Just Got Burned! What Is Wrong With This Gastric Pouch?

“…For GJA dilation in particular, APC has been used with promising results. 1 In the normal GI tract, the esophagus is lined with squamous epithelium, and the stomach is lined with columnar epithelium. One of the most well-known and well-documented scenarios in which the typical mucosal lining is replaced by abnormal mucosa is Barrett's esophagus (BE).…”

Efficacy of transoral outlet reduction in Roux-en-Y gastric bypass patients to promote weight loss: a systematic review and meta-analysis

“…The endoscopic gastric plication device (Stomaphyx; Endogastric Solutions, California, United States) did not demonstrate satisfactory weight loss [18]. TORe has shown promising results in a previous meta-analysis performed for all types of TORe procedures including plication devices, superficial suturing devices, Argon Plasma Coagulation (APC) and over-the-scope-clip (OTSC; Ovesco AG, Tubingen, Germany) [19]. Currently the full-thickness suturing device (Overstitch; Apollo Endosurgery, Texas, United States) with APC is the most commonly used device and this meta-analysis evaluated the efficacy and safety of TORe with this device as a therapeutic option for treating patients with weight regain after a RYGB.…”