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01-01-2018 | Review Article

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

Authors: Vitor Ottoboni Brunaldi, Pichamol Jirapinyo, Diogo Turiani H. de Moura, Ossamu Okazaki, Wanderley M. Bernardo, Manoel Galvão Neto, Josemberg Marins Campos, Marco Aurélio Santo, Eduardo G. H. de Moura

Published in: Obesity Surgery | Issue 1/2018

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.

World Health Organization. Obesity and overweight. [homepage on the Internet] Available from: http://www.who.int/gho/ncd/risk_factors/overweight_text/en/

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367–78.CrossRefPubMed

Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32. https://doi.org/10.1007/s11695-015-1657-z.CrossRefPubMed

Mehaffey JH, LaPar DJ, Clement KC, et al. 10-year outcomes after Roux-en-Y gastric bypass. Ann Surg. 2016;264(1):121–6.CrossRefPubMed

Obeid NR, Malick W, Concors SJ, et al. Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(1):11–20.CrossRef

Sjöström L, Lindroos AK, Peltonen M, et al. Swedish Obese Subjects Study Scientific Group: lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMed

Malli CP, Sioulas AD, Emmanouil T, et al. Endoscopy after bariatric surgery. Ann Gastroenterol: Q Publ Hell Soc Gastroenterol. 2016;29(3):249–57. https://doi.org/10.20524/aog.2016.0034.

Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2011;9:228–33.CrossRefPubMed

Yimcharoen P, Heneghan HM, Singh M, et al. Endoscopic findings and outcomes of revisional procedures for patients with weight recidivism after gastric bypass. Surg Endosc. 2011;25:3345–52.CrossRefPubMed

10.

Jirapinyo P, Dayyeh BK, Thompson CC. Gastrojejunal anastomotic reduction for weight regain in Roux-en-y gastric bypass patients: physiological, behavioral, and anatomical effects of endoscopic suturing and sclerotherapy. Surg Obes Relat Dis. 2016;12(10):1810–6. https://doi.org/10.1016/j.soard.2016.09.036.CrossRefPubMedPubMedCentral

11.

Kuzminov A, Palmer AJ, Wilkinson S, et al. Re-operations after secondary bariatric surgery: a systematic review. Obes Surg. 2016;26(9):2237–47. https://doi.org/10.1007/s11695-016-2252-7.CrossRefPubMed

12.

Kumar N, Thompson CC. Comparison of a superficial suturing device with a full-thickness suturing device for transoral outlet reduction (with videos). Gastrointest Endosc. 2014;79(6):984–9. https://doi.org/10.1016/j.gie.2014.02.006.CrossRefPubMedPubMedCentral

13.

Giurgius M, Fearing N, Weir A, et al. Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Endosc. 2014;28(5):1454–9. https://doi.org/10.1007/s00464-013-3376-7.CrossRefPubMed

14.

Baretta GA, Alhinho HC, Matias JE, et al. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass. Obes Surg. 2015;25(1):72–9. https://doi.org/10.1007/s11695-014-1363-2.CrossRefPubMed

15.

Heylen AM, Jacobs A, Lybeer M, et al. The OTSC®-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery. Obes Surg. 2011;21(10):1629–33. https://doi.org/10.1007/s11695-010-0253-5.CrossRefPubMed

16.

Borao F, Gorcey S, Capuano A. Prospective single-site case series utilizing an endolumenal tissue anchoring system for revision of post-RYGB stomal and pouch dilatation. Surg Endosc. 2010;24(9):2308–13. https://doi.org/10.1007/s00464-010-0919-z.CrossRefPubMed

17.

Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33. https://doi.org/10.1007/s11695-013-1070-4.CrossRefPubMed

18.

The Joanna Briggs Institute. Joanna Briggs Institute reviewers’ manual: 2016 edition. Available from http://joannabriggs.org/research/critical-appraisal-tools.html

19.

Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.CrossRefPubMed

20.

Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13. https://doi.org/10.1186/1471-2288-5-13.CrossRefPubMedPubMedCentral

21.

Derzon JH, Alford A. Forest plots in Excel: moving beyond a clump of trees to a forest of visual information. Practical Assessment, Research and Evaluation. Vol 8 N 7. 2013. Available from: https://www.researchgate.net/publication/236414258_Forest_plots_in_Excel_Moving_beyond_a_clump_of_trees_to_a_forest_of_visual_information.

22.

Jirapinyo P, Slattery J, Ryan MB, et al. Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Endoscopy. 2013;45(7):532–6. https://doi.org/10.1055/s-0032-1326638.CrossRefPubMed

23.

Landi R, Boskoski I, Familiari P, Tringali A, Perri V, Costamagna G. Transoral outlet reduction for therapy of weight regain after gastric bypass. Gastrointest Endosc. 2016; 83:5 SUPPL. 1 (AB311).

24.

Goyal D, Kim S, Dutson E, et al. Endoscopic trans-oral outlet reduction in combination with gastroplasty (TORe-G) is a novel technique that is highly efficacious and safe for weight loss in patients with failed Roux-en-Y gastric bypass (RYGB). Am J Gastroenterol. 2015;110:S628–84. https://doi.org/10.1038/ajg.2015.272.CrossRef

25.

Riva P, Perretta S, Swanstrom L. Weight regain following RYGB can be effectively treated using a combination of endoscopic suturing and sclerotherapy. Surg Endosc. 2016; https://doi.org/10.1007/s00464-016-5189-y.

26.

Gallo AS, DuCoin CG, Berducci MA, et al. Endoscopic revision of gastric bypass: holy grail or epic fail? Surg Endosc. 2016;30(9):3922–7. https://doi.org/10.1007/s00464-015-4699-3.CrossRefPubMed

27.

Eid GM, McCloskey CA, Eagleton JK, et al. StomaphyX vs a sham procedure for revisional surgery to reduce regained weight in Roux-en-Y gastric bypass patients. JAMA Surg. 2014;149(4):372–9. https://doi.org/10.1001/jamasurg.2013.4051.CrossRefPubMed

28.

Ong’uti SK, Ortega G, Onwugbufor MT, et al. Effective weight loss management with endoscopic gastric plication using StomaphyX device: is it achievable? Surg Obes Relat Dis. 2013;9(1):113–7. https://doi.org/10.1016/j.soard.2011.08.025.CrossRefPubMed

29.

Ryou M, Mullady DK, Lautz DB, et al. Pilot study evaluating technical feasibility and early outcomes of second-generation endosurgical platform for treatment of weight regain after gastric bypass surgery. Surg Obes Relat Dis. 2009;5(4):450–4. https://doi.org/10.1016/j.soard.2009.03.217.CrossRefPubMed

30.

Mullady D, Lautz DB, Thompson CC. Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). Gastrointest Endosc. 2009;70(3):440–4. https://doi.org/10.1016/j.gie.2009.01.042.CrossRefPubMed

31.

Sung B, Leva N, Ahmed S, et al. Does stomaphyx treat weight gain and comorbidity recurrence following RYGB? Surg Endosc. 2013;27:304. https://doi.org/10.1007/s00464-013-2881-z. CrossRef

32.

Arellano JJ. Prospective case series utilizing an endoscopic suturing system for revision of gastrojejunal stoma dilatation following Roux-en-Y gastric bypass. Gastrointest Endosc. 2014;79(5, SUPPL):AB194, ISSN 0016–5107. https://doi.org/10.1016/j.gie.2014.05.009.CrossRef

33.

Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc. 2016;83(4):776–9. https://doi.org/10.1016/j.gie.2015.08.039.CrossRefPubMed

34.

Patel LY, Stringer TJ, Gitelis ME, et al. After 48 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-y gastric bypass: what have we learned? Surg Endosc. 2016;30:211. https://doi.org/10.1007/s00464-016-4770-8.CrossRef

35.

Vargas EJ, Rustagi T, McCarty TR, et al. Transoral outlet reduction (TORe) with full thickness endoscopic suturing for weight regain after gastric bypass: Single Center Experience With Systematic Review of the Literature. Gastrointest Endosc. 2016;83(5, SUPPL):AB505–AB506, ISSN 0016–5107. https://doi.org/10.1016/j.gie.2016.03.733.CrossRef

36.

Schulman A, Abidi WM, Thompson CCA, et al. Approach for tissue exposure is technically feasible prior to endoscopic suturing for failed gastric bypass. Gastrointest Endosc. 2016;83(5, SUPPL):AB504, ISSN 0016–5107. https://doi.org/10.1016/j.gie.2016.03.729.

37.

Schulman A, Thompson CC. A second generation plication device provides safe and effective treatment of weight regain in gastric bypass patients. Gastrointest Endosc. 2016;83(5, SUPPL):AB504, ISSN 0016–5107. https://doi.org/10.1016/j.gie.2016.03.728.

38.

Gitelis M, Ujiki M, Farwell L, et al. Six month outcomes in patients experiencing weight gain after gastric bypass who underwent gastrojejunal revision using an endoluminal suturing device. Surg Endosc. 2015;29(8):2133–40. https://doi.org/10.1007/s00464-014-3954-3.CrossRefPubMed

39.

Gitelis ME, Linn JG, Denham W, et al. One-year outcomes following endoscopic gastrojejunal revision. Gastroenterology. 2015;148(4 SUPPL. 1):S1188–9.CrossRef

40.

Kumar N, Thompson CC. Transoral outlet reduction (TORe) for weight regain after gastric bypass: long-term follow-up and number needed to treat. Gastroenterology. 2014;146(5 SUPPL. 1):S724–5. https://doi.org/10.1016/S0016-5085(14)62627-5.CrossRef

41.

Goyal V, Holover S, Garber S. Gastric pouch reduction using StomaphyX in post Roux-en-Y gastric bypass patients does not result in sustained weight loss: a retrospective analysis. Surg Endosc. 2013;27(9):3417–20. https://doi.org/10.1007/s00464-013-2905-8.CrossRefPubMed

42.

Thompson CC, Jacobsen GR, Schroder GL, et al. Stoma size critical to 12-month outcomes in endoscopic suturing for gastric bypass repair. Surg Obes Relat Dis. 2012;8(3):282–7. https://doi.org/10.1016/j.soard.2011.03.014.CrossRefPubMed

43.

Raman SR, Holover S, Garber S. Endolumenal revision obesity surgery results in weight loss and closure of gastric-gastric fistula. Surg Obes Relat Dis. 2011;7(3):304–8. https://doi.org/10.1016/j.soard.2011.01.045.CrossRefPubMed

44.

Mikami D, Needleman B, Narula V, et al. Natural orifice surgery: initial US experience utilizing the StomaphyX™ device to reduce gastric pouches after Roux-en-Y gastric bypass. Surg Endosc. 2010;24(1):223–8. https://doi.org/10.1007/s00464-009-0640-y.CrossRefPubMed

45.

Horgan S, Jacobsen G, Weiss GD, et al. Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis. 2010;6(3):290–5. https://doi.org/10.1016/j.soard.2009.12.011.CrossRefPubMed

46.

Leitman IM, Virk CS, Avgerinos DV, et al. Early results of trans-oral endoscopic plication and revision of the gastric pouch and stoma following Roux-en-Y gastric bypass surgery. JSLS. 2010;14(2):217–20. https://doi.org/10.4293/108680810X12785289144241.CrossRefPubMedPubMedCentral

47.

Thompson CC, Chand B, Chen YK, et al. Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology. 2013;145(1):129–137.e3. https://doi.org/10.1053/j.gastro.2013.04.002.CrossRefPubMed

48.

Roll S, D’Assuncão MA. Natural orifice surgery: initial Brazilian experience utilizing the stomaphyxtm device to reduce gastric pouches and gastrojejunostomy anastomosis (stoma) after Roux-en-Y gastric bypass. Surg Endosc. 2010;24(Suppl 1):314. https://doi.org/10.1007/s00464-010-0972-7.

49.

Fittipaldi-Fernandez RJ, Diestel CF. A new approach in the treatment of weight regain after bariatric surgery: the argon plasma coagulation of the anastomosis. Gastroenterology. 2015;148(4 SUPPL. 1):S901. Date of Publication: April 2015

50.

Ward ZJ, Long MW, Resch SC, et al. Redrawing the US obesity landscape: bias-corrected estimates of state-specific adult obesity prevalence. PLoS One. 2016;11:e0150735.CrossRefPubMedPubMedCentral

51.

Evans JA et al. The role of endoscopy in the bariatric surgery patient. Gastrointest Endosc. 81(5):1063–72.

52.

Yoon PW, Bastian B, Anderson RN, et al. Potentially preventable deaths from the five leading causes of death—United States, 2008–2010. MMWR Morb Mortal Wkly Rep. 2014;63(17):369–74.PubMed

53.

Busetto L, Dixon J, De Luca M, et al. Bariatric surgery in class I obesity. A position statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2014;24(4):487–519.CrossRefPubMed

54.

ASMBS Clinical Issues Committee. Bariatric surgery in class I obesity (body mass index 30–35 kg/m²). Surg Obes Relat Dis. 2013;9(1):e1–10.CrossRef

55.

Kofman MD, Lent MR, Swencionis C. Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an Internet survey. Obesity (Silver Spring). 2010;18(10):1938–43.CrossRef

56.

Christou NV, Look D, Maclean LD. Weight gain after short and long-limb gastric bypass in patients followed by longer than 10 years. Ann Surg. 2006;244(5):734–49.CrossRefPubMedPubMedCentral

57.

ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy, Ginsberg GG, Chand B, et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc. 2011;74(5):943–53. https://doi.org/10.1016/j.gie.2011.08.053.CrossRef

Title: Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis
Authors: Vitor Ottoboni Brunaldi
Pichamol Jirapinyo
Diogo Turiani H. de Moura
Ossamu Okazaki
Wanderley M. Bernardo
Manoel Galvão Neto
Josemberg Marins Campos
Marco Aurélio Santo
Eduardo G. H. de Moura
Publication date: 01-01-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 1/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-2986-x

At a glance: The STEP trials

Springer Medicine

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

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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