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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.

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Abbreviations

RYGB:

Roux-en-Y gastric bypass

GJA:

Gastrojejunal anastomosis

APC:

Argon plasma coagulation

TORe:

Transoral outlet reduction

PROSPERO:

International Prospective Register of Systematic Reviews

BMI:

Body mass index

AWL:

Absolute weight loss

EWL:

Excess weight loss

TBWL:

Total body weight loss

SD:

Standard deviation

SE:

Standard error

ST:

Superficial thickness

FT:

Full thickness

FTS:

Full-thickness endoscopic suturing

FTS-APC:

Full-thickness endoscopic suturing plus argon plasma coagulation

OTSC:

Over-the-scope clip

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Correspondence to Vitor Ottoboni Brunaldi.

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Dr. Galvao Neto reports personal fees from Apollo Endosurgery, Fractyl Labs, GI Windows, GI Dynamics, Ethicom Endosurgery, and Alacer Biomedica outside the submitted work. All other authors have nothing to declare.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Brunaldi, V.O., Jirapinyo, P., de Moura, D.T.H. et al. Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis. OBES SURG 28, 266–276 (2018). https://doi.org/10.1007/s11695-017-2986-x

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Keywords

  • Roux-en-Y gastric bypass
  • Bariatrics
  • Bariatric surgery
  • Weight regain
  • Endoscopy
  • Endoscopic suturing
  • Obesity