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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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A Correction to this article was published on 19 May 2020

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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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Change history

  • 19 May 2020

    In the original article the captions for Figs.��1-3 are incorrect.

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Author information

Authors and Affiliations

  1. Faculty of Medicine of ABC, Santo Andre, São Paulo, Brazil

    Luiz Gustavo de Quadros, Manoel Galvão Neto, João Caetano Marchesini, Eduardo Grecco, Admar Concon Filho & Almino Cardoso Ramos

  2. Beneficência Portuguesa Hospital, Sao Jose do Rio Preto, São Paulo, Brazil

    Luiz Gustavo de Quadros

  3. Kaiser Day Hospital, Sao Jose do Rio Preto, São Paulo, Brazil

    Luiz Gustavo de Quadros

  4. Federal University of Pernambuco, Recife, Pernambuco, Brazil

    Luiz Gustavo de Quadros, Lyz Bezerra da Silva, Álvaro Antônio Bandeira Ferraz & Josemberg Marins Campos

  5. Endovitta Institute, Sao Paulo, São Paulo, Brazil

    Manoel Galvão Neto

  6. Orlando Health Hospital, Orlando, USA

    André Teixeira

  7. Beneficência Portuguesa Hospital, Sao Jose do Rio Preto, São Paulo, Brazil

    Roberto Luiz Kaiser Junior

  8. Kaiser Day Hospital, Sao Jose do Rio Preto, São Paulo, Brazil

    Roberto Luiz Kaiser Junior & Idiberto José Zotarelli Filho

  9. Jackson North Medical Center, University at Buffalo, Miami, USA

    Natan Zundel

  10. Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil

    Thiago Ferreira de Souza

  11. Gastro Obeso Center, Sao Paulo, Brazil

    Almino Cardoso Ramos

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  1. Luiz Gustavo de Quadros
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  2. Manoel Galvão Neto
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Corresponding author

Correspondence to Luiz Gustavo de Quadros.

Ethics declarations

The institutional review board of the Beneficência Portuguesa Hospital, Brazil, approved the study. All participants provided informed consent before the implementation of any study protocol. This study has been registered with clinicaltrials.gov (protocol NCT03055754).

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The authors declare that they have no conflict of interest related with this manuscript.

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de Quadros, L.G., Neto, M.G., Marchesini, J.C. et al. Endoscopic Argon Plasma Coagulation vs. Multidisciplinary Evaluation in the Management of Weight Regain After Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group. OBES SURG 30, 1904–1916 (2020). https://doi.org/10.1007/s11695-020-04414-6

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