Good Clinical Practices on Argon Plasma Coagulation Treatment for Weight Regain Associated with Dilated Gastrojejunostomy Following Roux-en-Y Gastric Bypass: a Brazilian-Modified Delphi Consensus

Neto, Manoel Galvão; Brunaldi, Vítor Ottoboni; Grecco, Eduardo; Silva, Lyz Bezerra; Quadros, Luiz Gustavo de; Souza, Thiago Ferreira de; Teixeira, André; Morais, Helmut Wagner Poti de; Lima, João Henrique Felício de; Filho, Admar Concon; Amorim, Artagnan Menezes Barbosa de; Galvao, Manoela; Teixeira, Newton; Marchesini, João Caetano

doi:10.1007/s11695-021-05795-y

Cited by 8 publications

(6 citation statements)

References 33 publications

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“…Patients in the latter group received additional ablation sessions every 6 weeks until the stoma size reached 12 mm or up to a maximum of three sessions as per previous literature [13]. To avoid interobserver disagreement, the same operator assessed all GJA diameters using standard foreign body forceps per literature recommendation [14].…”

Section: Methodsmentioning

confidence: 99%

“…Aside from the physiology and natural history perspective, the redilation of the GJA precipitates another discussion concerning the current follow-up strategy. Most centers implement a multidisciplinary approach to address weight regain and to assist patients in retaining their weight loss [14,25]. However, neither a standardized endoscopic follow-up nor well-defined criteria currently exist to indicate reTORe.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?

et al. 2023

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Background and study aim: Significant weight regain affects up to a third of patients after Roux-en-Y Gastric Bypass (RYGB) and demands treatment. The transoral outlet reduction (TORe) with Argon Plasma Coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short. However, no study has investigated the course of the gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedural year. Patients and methods: Patients eligible for a 36-month follow-up visit after TORe underwent upper GI endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJA size. Comparisons between APC and APC-FTS TORe were a secondary aim. Results: Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to preprocedural levels. Only the energy/fatigue domain improvement was kept between the one and 3-year visits. Conclusions: Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered an iterant rather than a one-off procedure.

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Section: Methodsmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?

et al. 2023

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“…Pouch length was measured via standard scope markings, and GJA diameter was estimated visually relative to the endoscope and/or endoscopic tools, as is standard practice in TORe. 30,31 If present, visible surgical material was removed from the GJA with forceps and/or endoscopic scissors. If no contraindications to ER-OAGB were identified, gastric tissue surrounding the GJA was circumferentially ablated using argon plasma coagulation (80 W, 1.2 L/min) for a golden-brown effect approximately 5–10 mm in width.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic revision of one-anastomosis gastric bypass (ER-OAGB) for weight recurrence: a case series of 17 adults

Maselli,

Hoff,

Kucera

et al. 2023

Clin Med Insights Gastroenterol

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Weight recurrence after one-anastomosis gastric bypass (OAGB), the third most common metabolic and bariatric surgery performed worldwide, is observed in a subset of patients due to the chronic, progressive nature of obesity. Endoscopic revision of the OAGB (ER-OAGB) through full-thickness suturing to reduce the gastrojejunal anastomosis and gastric pouch is a potential alternative to surgical revision. Here, we present a case series of ER-OAGB and long-term nutritional support at two international centers with expertise in bariatric endoscopy. Data were retrospectively evaluated from a prospectively maintained database. The primary outcome was total body weight loss (TBWL) at 12 months. Secondary outcomes included TBWL at 3, 6, and 15 months; excess weight loss (EWL) at 3, 6, 12, and 15 months; frequency of new/worsening symptoms of gastroesophageal reflux disease (GERD); and the frequency of serious adverse events. In this series, 17 adults (70.6% female, mean age 46.8 years, mean BMI 39.1 kg/m2) successfully underwent ER-OAGB an average of 8 years (range 2–21 years) after OAGB for a mean weight recurrence of 43.2% (range 10.9–86.9%). TBWL from ER-OAGB was 9.7 ± 1.8% at 3 months, 13.4 ± 3.5% at 6 months, 18.5 ± 2.1% at 12 months, and 18.1 ± 2.2% at 15 months. EWL from ER-OAGB was 30.5 ± 14.7% at 3 months, 42.6 ± 16.2% at 6 months, 54.2 ± 11.3% at 12 months, and 54.2 ± 11.7% at 15 months. There were no instances of new/worsening GERD symptoms or serious adverse events. In this small series of adults who experienced weight recurrence after OAGB, ER-OAGB facilitated safe and clinically meaningful weight loss, without new or worsening GERD symptoms, when performed by experienced bariatric endoscopists in concert with longitudinal nutritional support.

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“…First, an endoscopic evaluation with a single-channel gastroscope was performed to identify anatomy, including the gastric pouch, GJA, and blind and efferent limbs of the jejunum. TORe diameter was estimated by standard foreign body forceps, as implemented in guidelines and studies of TORe[ 17 , 18 ]. If present, visible surgical material was removed from the GJA with forceps and/or endoscopic scissors.…”

Section: Methodsmentioning

confidence: 99%

Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

Maselli,

Chittajallu,

Wooley

et al. 2023

World J Gastrointest Endosc

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BACKGROUND Transoral outlet reduction (TORe) is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass (RYGB) for weight recurrence; however, little has been published on its clinical implementation in the community setting. AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB. METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022. Patients were provided longitudinal nutritional support via virtual visits. The primary outcome was total body weight loss (TBWL) at twelve months from TORe. Secondary outcomes included TBWL at three months and six months; excess weight loss (EWL) at three, six, and twelve months; twelve-month TBWL by obesity class; predictors of twelve-month TBWL; rates of post-TORe stenosis; and serious adverse events (SAE). Outcomes were reported with descriptive statistics. RESULTS Two hundred eighty-four adults (91.9% female, age 51.3 years, body mass index 39.3 kg/m 2 ) underwent TORe an average of 13.3 years after RYGB. Median pre- and post-TORe outlet diameter was 35 mm and 8 mm, respectively. TBWL was 11.7% ± 4.6% at three months, 14.3% ± 6.3% at six months, and 17.3% ± 7.9% at twelve months. EWL was 38.4% ± 28.2% at three months, 46.5% ± 35.4% at six months, and 53.5% ± 39.2% at twelve months. The number of follow-up visits attended was the strongest predictor of TBWL at twelve months (R 2 = 0.0139, P = 0.0005). Outlet stenosis occurred in 11 patients (3.9%) and was successfully managed with endoscopic dilation. There was one instance of post-procedural nausea requiring overnight observation (SAE rate 0.4%). CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support, purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

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Good Clinical Practices on Argon Plasma Coagulation Treatment for Weight Regain Associated with Dilated Gastrojejunostomy Following Roux-en-Y Gastric Bypass: a Brazilian-Modified Delphi Consensus

Cited by 8 publications

References 33 publications

Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?

Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?

Endoscopic revision of one-anastomosis gastric bypass (ER-OAGB) for weight recurrence: a case series of 17 adults

Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

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