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Endoscopic Argon Plasma Coagulation vs. Multidisciplinary Evaluation in the Management of Weight Regain After Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group

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ARTICLE DOWNLOAD

Endoscopic Argon Plasma Coagulation vs. Multidisciplinary Evaluation in the Management of Weight Regain After Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group

10$

Luiz Gustavo de Quadros, Manoel Galvão Neto, João Caetano Marchesini, André Teixeira, Eduardo Grecco, Roberto Luiz Kaiser Junior, Natan Zundel, Idiberto José Zotarelli Filho, Thiago Ferreira de Souza, Admar Concon Filho, Lyz Bezerra da Silva, Almino Cardoso Ramos, Álvaro Antônio Bandeira Ferraz & Josemberg Marins Campos 

Abstract

Background

Roux-en-Y gastric bypass is one of the most widely performed bariatric surgeries. However, the relapse of obesity occurs in approximately 20% of patients and enlargement of the anastomosis is one of the factors associated with this relapse. Endoscopic treatment of the anastomosis has been proposed to assist in renewed weight loss. One endoscopic technique is the narrowing of the anastomosis argon plasma coagulation (APC). Objective: Evaluate the effectiveness and safety of the endoscopic treatment of an enlarged anastomosis with APC.

Methods

A randomized controlled study was conducted comparing APC to exclusive multidisciplinary management after weight regain.

Results

Forty-two patients were divided into two groups: APC (n = 22) and control (n = 20). After 14 months of follow-up with a crossover at 6 months, significant improvement in satiety and greater weight loss were found in the APC group and after crossover. APC was associated with significant weight loss [9.73 (7.46, 12) vs. + 1.38 (− 1.39, 2.15)], a reduction in the anastomosis diameter [p < 0.001], early satiation [0.77 (0.44, 1.11) vs. − 0.59 (− 0.95, − 0.23), p < 0.001], and increased quality of life measured using the EQ5D index [p = 0.04] and EQ5D VAS scale [p = 0.04]. Considering total mean weight loss throughout the entire follow-up, weight loss was similar in both groups (13.02 kg in the APC and 11.52 kg in the control).

Conclusion

Treatment of the gastrojejunal anastomosis with APC was effective and safe, with significant weight loss, the return of early satiation, and an improvement in quality of life.

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Year 2020
Language English
Format PDF
DOI 10.1007/s11695-020-04414-6