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Endoscopic Management of Weight Regain

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Gastrointestinal Interventional Endoscopy

Abstract

Bariatric and metabolic surgery remains the most effective long-term treatment option for obesity and its associated comorbidities. However, following bariatric surgery, a significant proportion of patients experience weight recidivism or fail to achieve significant weight loss. The etiology behind these weight trajectories can be multifactorial, and a variety of endoscopic treatment approaches are available that form part of a comprehensive treatment approach for these patients. With the increasing number of bariatric surgeries being performed, endoscopists should become familiar with available techniques and consider adding them to their endoscopic skill set. This chapter will review the endoscopic treatments for weight regain, with a focus on endoscopic transoral outlet reduction (TORe) using full-thickness suturing in the post Roux-en-Y bypass surgery population.

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References

  1. Releases CN. Cancers associated with overweight and obesity make up 40 percent of cancers diagnosed in the United States 2017 [11/11/2017]. Available from: https://www.cdc.gov/media/releases/2017/p1003-vs-cancer-obesity.html.

  2. Organization WH. Global Health Observatory (GHO) data: overweight and obesity 2016 [11/11/2017]. Available from: http://www.who.int/gho/ncd/risk_factors/overweight_text/en/(2016).

  3. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41. Epub 2010/01/15. PubMed PMID: 20071471. https://doi.org/10.1001/jama.2009.2014.

    Article  CAS  PubMed  Google Scholar 

  4. Diabetes Prevention Program Research G. The diabetes prevention program (DPP): description of lifestyle intervention. Diabetes Care. 2002;25(12):2165–71. Epub 2002/11/28. PubMed PMID: 12453955; PubMed Central PMCID: PMCPMC1282458

    Article  Google Scholar 

  5. The Look ARG. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22(1):5–13. https://doi.org/10.1002/oby.20662. PubMed PMID: PMC3904491

    Article  Google Scholar 

  6. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55. https://doi.org/10.1056/NEJMoa1700459. Epub 2017/09/21. PubMed PMID: 28930514; PubMed Central PMCID: PMCPMC5737957

    Article  PubMed  PubMed Central  Google Scholar 

  7. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641. Epub 2014/08/12. PubMed PMID: 25105982. https://doi.org/10.1002/14651858.CD003641.pub4.

    Article  Google Scholar 

  8. Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF. Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obes Surg. 2015;25(8):1474–81. Epub 2015/01/18. PubMed PMID: 25595383. https://doi.org/10.1007/s11695-014-1560-z.

    Article  PubMed  Google Scholar 

  9. Maciejewski ML, Arterburn DE, Van Scoyoc L, Smith VA, Yancy WS Jr, Weidenbacher HJ, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55. https://doi.org/10.1001/jamasurg.2016.2317. Epub 2016/09/01. PubMed PMID: 27579793; PubMed Central PMCID: PMCPMC5112115

    Article  PubMed  PubMed Central  Google Scholar 

  10. Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33. https://doi.org/10.1007/s11695-013-1070-4.

    Article  PubMed  Google Scholar 

  11. Jirapinyo P, Abu Dayyeh BK, Thompson CC. Weight regain after Roux-en-Y gastric bypass has a large negative impact on the bariatric quality of life index. BMJ Open Gastroenterol. 2017;4(1):e000153. https://doi.org/10.1136/bmjgast-2017-000153. Epub 2017/09/26. PubMed PMID: 28944069; PubMed Central PMCID: PMCPMC5596836

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis. 2008;4(5, Suppl):S109–S84. https://doi.org/10.1016/j.soard.2008.08.009.

    Article  PubMed  Google Scholar 

  13. Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51. Epub 2008/04/09. PubMed PMID: 18392907. https://doi.org/10.1007/s11695-007-9265-1.

    Article  PubMed  Google Scholar 

  14. Catalano MF, Rudic G, Anderson AJ, Chua TY. Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc. 2007;66(2):240–5. Epub 2007/03/03. PubMed PMID: 17331511. https://doi.org/10.1016/j.gie.2006.06.061.

    Article  PubMed  Google Scholar 

  15. Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2011;9(3):228–33. https://doi.org/10.1016/j.cgh.2010.11.004. Epub 2010/11/26. PubMed PMID: 21092760; PubMed Central PMCID: PMCPMC3043151

    Article  PubMed  Google Scholar 

  16. Heneghan HM, Yimcharoen P, Brethauer SA, Kroh M, Chand B. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis. 2012;8(4):408–15. Epub 2011/11/08. PubMed PMID: 22055390. https://doi.org/10.1016/j.soard.2011.09.010.

    Article  PubMed  Google Scholar 

  17. Yimcharoen P, Heneghan HM, Singh M, Brethauer S, Schauer P, Rogula T, et al. Endoscopic findings and outcomes of revisional procedures for patients with weight recidivism after gastric bypass. Surg Endosc. 2011;25(10):3345–52. Epub 2011/05/03. PubMed PMID: 21533520. https://doi.org/10.1007/s00464-011-1723-0.

    Article  PubMed  Google Scholar 

  18. Spyropoulos C, Kehagias I, Panagiotopoulos S, Mead N, Kalfarentzos F. Revisional bariatric surgery: 13-year experience from a tertiary institution. Arch Surg. 2010;145(2):173–7. Epub 2010/02/17. PubMed PMID: 20157086. https://doi.org/10.1001/archsurg.2009.260.

    Article  PubMed  Google Scholar 

  19. Giurgius M, Fearing N, Weir A, Micheas L, Ramaswamy A. Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Endosc. 2014;28(5):1454–9. Epub 2014/01/31. PubMed PMID: 24477936. https://doi.org/10.1007/s00464-013-3376-7.

    Article  PubMed  Google Scholar 

  20. Abu Dayyeh BK, Jirapinyo P, Weitzner Z, Barker C, Flicker MS, Lautz DB, et al. Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures. Gastrointest Endosc. 2012;76(2):275–82. https://doi.org/10.1016/j.gie.2012.03.1407. Epub 2012/07/24. PubMed PMID: 22817783; PubMed Central PMCID: PMCPMC4428559

    Article  PubMed  PubMed Central  Google Scholar 

  21. Aly A. Argon plasma coagulation and gastric bypass—a novel solution to stomal dilation. Obes Surg. 2008;19(6):788. https://doi.org/10.1007/s11695-008-9763-9.

    Article  PubMed  Google Scholar 

  22. Baretta GA, Alhinho HC, Matias JE, Marchesini JB, de Lima JH, Empinotti C, et al. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass. Obes Surg. 2015;25(1):72–9. Epub 2014/07/10. PubMed PMID: 25005812. https://doi.org/10.1007/s11695-014-1363-2.

    Article  PubMed  Google Scholar 

  23. Brunaldi VO, Jirapinyo P, de Moura DTH, Okazaki O, Bernardo WM, Galvão Neto M, et al. Endoscopic treatment of weight regain following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg. 2018;28(1):266–76. https://doi.org/10.1007/s11695-017-2986-x.

    Article  PubMed  Google Scholar 

  24. Eid GM, McCloskey CA, Eagleton JK, Lee LB, Courcoulas AP. StomaphyX vs a sham procedure for revisional surgery to reduce regained weight in Roux-en-Y gastric bypass patients: a randomized clinical trial. JAMA Surg. 2014;149(4):372–9. Epub 2014/02/21. PubMed PMID: 24554030. https://doi.org/10.1001/jamasurg.2013.4051.

    Article  PubMed  Google Scholar 

  25. Horgan S, Jacobsen G, Weiss GD, Oldham JS Jr, Denk PM, Borao F, 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. Epub 2010/06/01. PubMed PMID: 20510293. https://doi.org/10.1016/j.soard.2009.12.011.

    Article  PubMed  Google Scholar 

  26. 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. Epub 2014/04/12. PubMed PMID: 24721521; PubMed Central PMCID: PMCPMC5038592. https://doi.org/10.1016/j.gie.2014.02.006.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Vargas EJ, Bazerbachi F, Rizk M, Rustagi T, Acosta A, Wilson EB, et al. Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc. 2017. Epub 2017/07/01. PubMed PMID: 28664438; https://doi.org/10.1007/s00464-017-5671-1.

    Article  Google Scholar 

  28. Schulman AR, Kumar N, Thompson CC. Transoral outlet reduction: a comparison of purse-string with interrupted stitch technique. Gastrointest Endosc. 2017. Epub 2017/11/08. PubMed PMID: 29108984; https://doi.org/10.1016/j.gie.2017.10.034.

    Article  Google Scholar 

  29. Jirapinyo P, Kroner PT, Thompson CC. Purse-string transoral outlet reduction (TORe) is effective at inducing weight loss and improvement in metabolic comorbidities after Roux-en-Y gastric bypass. Endoscopy. 2017. Epub 2017/12/19. PubMed PMID: 29253919; https://doi.org/10.1055/s-0043-122380.

    PubMed  Google Scholar 

  30. Abrams JA, Komanduri S, Shaheen NJ, Wang Z, Rothstein RI. Radiofrequency ablation for the treatment of weight regain after Roux-en-Y gastric bypass surgery. Gastrointest Endosc. 2018;87(1):275–9.e2. https://doi.org/10.1016/j.gie.2017.06.030.

    Article  PubMed  Google Scholar 

  31. Eid G. Sleeve gastrectomy revision by endoluminal sleeve plication gastroplasty: a small pilot case series. Surg Endosc. 2017;31(10):4252–5. Epub 2017/04/02. PubMed PMID: 28364152. https://doi.org/10.1007/s00464-017-5469-1.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Eric J. Vargas, Andrew C. Storm & Fateh Bazerbachi

  2. Mayo Clinic, Rochester, MN, USA

    Barham K. Abu Dayyeh

Authors
  1. Eric J. Vargas
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  2. Andrew C. Storm
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  3. Fateh Bazerbachi
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  4. Barham K. Abu Dayyeh
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Corresponding author

Correspondence to Barham K. Abu Dayyeh .

Editor information

Editors and Affiliations

  1. Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA

    Mihir S. Wagh

  2. Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA

    Sachin B. Wani

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Vargas, E.J., Storm, A.C., Bazerbachi, F., Abu Dayyeh, B.K. (2020). Endoscopic Management of Weight Regain. In: Wagh, M., Wani, S. (eds) Gastrointestinal Interventional Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-21695-5_16

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  • DOI: https://doi.org/10.1007/978-3-030-21695-5_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21694-8

  • Online ISBN: 978-3-030-21695-5

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