Gastric Bypass pp 337-345 | Cite as

Endoscopic Treatment of Weight Regain After Gastric Bypass

  • Luiz Gustavo de Quadros
  • Manoel Galvão Neto
  • Eduardo Grecco
  • Thiago Ferreira de Souza
  • Idiberto José Zotarelli Filho
  • Andre Fernandes Teixeira


According to the IFSO report issued in 2015, approximately 86 thousand bariatric surgeries have been performed in Brazil, the second most frequent of which is gastric bypass. The most common late-onset complication is the return of obesity, with weight regain and the recurrence of previously controlled comorbidities. As a consequence of weight regain, abnormal anatomic findings are encountered in 71.2% of patients: 58.9% with dilation of the gastrojejunal anastomosis, 28.8% with dilation of the pouch, and 12.3% with both types of dilation. Endoscopic methods for the treatment of the anastomosis and pouch are performed to exert an influence on weight regain.


Gastric bypass Gastrojejunal anastomosis Pouch Argon plasma Suturing Surgery 


  1. 1.
    Abu Dayyed BK, Acosta A, Camilleri M, Mundi MS, Rajan E, Topazian MD, Gostout CJ. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol. 2017;15(1):37–43.e1.CrossRefGoogle Scholar
  2. 2.
    IBGE- Instituto Brasileiro de Geografia e Estatística. Disponível em: Acesso em março de 2016.
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    OMS- Organização Mundial de Saúde. Disponível em: Acesso em: 25 de setembro de 2018.
  5. 5.
    Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.CrossRefGoogle Scholar
  6. 6.
    Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefGoogle Scholar
  7. 7.
    Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9(1):13–27.CrossRefGoogle Scholar
  8. 8.
    Malick KJ. Clinical applications of argon plasma coagulation in endoscopy. Gastroenterol Nurs. 2006;29(5):386–91; quiz 92–3CrossRefGoogle Scholar
  9. 9.
    Aly A. Argon plasma coagulation and gastric bypass–a novel solution to stomal dilation. Obes Surg. 2009;19(6):788–90.CrossRefGoogle Scholar
  10. 10.
    Thompson CC, Slattery J, Bundga ME, Lautz DB. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc. 2006;20(11):1744–8.CrossRefGoogle Scholar
  11. 11.
    Miranda da Rocha LC, Ayub Perez OA, Arantes V. Endoscopic management of bariatric surgery complications: what the gastroenterologist should know. Rev Gastroenterol Mex. 2016;81(1):35–47.PubMedGoogle Scholar
  12. 12.
    Galvao Neto M, Marins Campos J. Therapeutic flexible endoscopy after bariatric surgery: a solution for complex clinical scenarios. Cir Esp. 2015;93(1):1–3.CrossRefGoogle Scholar
  13. 13.
    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.CrossRefGoogle Scholar
  14. 14.
    De Quadros LG, Galvao Neto MD, Campos JM, Kaiser Junior RL, Grecco E, Flamini Junior M, et al. Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study. BMC Res Notes. 2017;10(1):13.CrossRefGoogle Scholar
  15. 15.
    Ramos AC, Marchesini JC, de Souza Bastos EL, Ramos MG, de Souza MDG, Campos JM, et al. The role of gastrojejunostomy size on gastric bypass weight loss. Obes Surg. 2017;27:2317.CrossRefGoogle Scholar
  16. 16.
    Thompson CC, Chand B, Chen YK, Demarco DC, Miller L, Schweitzer M, et al. Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology. 2013;145(1):129–37.e3.CrossRefGoogle Scholar
  17. 17.
    Flanagan L. Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg, Oxford. 1996;6:38–43.CrossRefGoogle Scholar
  18. 18.
    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.CrossRefGoogle Scholar
  19. 19.
    Trindade EM, Gebara T, Cambi MPC, Baretta GAP. Nutritional aspects and the use of nutritional supplements by women who underwent gastric bypass. Arq Bras Cir Dig. 2017;30(1):11–3.CrossRefGoogle Scholar
  20. 20.
    Bege T, Emungania O, Vitton V, Ah-Soune P, Nocca D, Noel P, et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc. 2011;73(2):238–44.CrossRefGoogle Scholar
  21. 21.
    Boules M, Chang J, Haskins IN, Sharma G, Froylich D, El-Hayek K, et al. Endoscopic management of post-bariatric surgery complications. World J Gastrointest Endosc. 2016;8(17):591–9.CrossRefGoogle Scholar
  22. 22.
    Dakin GF, Eid G, Mikami D, Pryor A, Chand B, American Society for M, et al. Endoluminal revision of gastric bypass for weight regain–a systematic review. Surg Obes Relat Dis. 2013;9(3):335–42.CrossRefGoogle Scholar
  23. 23.
    Jirapinyo P, Slattery J, Ryan MB, Abu Dayyeh BK, Lautz DB, Thompson CC. 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.CrossRefGoogle Scholar
  24. 24.
    Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc. 2016;83(4):776–9.CrossRefGoogle Scholar
  25. 25.
    Heylen AM, Jacobs A, Lybeer M, Prosst RL. The OTSC(R)-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery. Obes Surg. 2011;21(10):1629–33.CrossRefGoogle Scholar
  26. 26.
    Schulman A, Chan WW, Thompson CC. Endoscopic suturing for failed gastric by-pass: predictors of success. AGA. 2013;abstracts S–827 Mo1958.Google Scholar
  27. 27.
    Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol. 1994;2:42–6.PubMedGoogle Scholar
  28. 28.
    De Souza LM, de Quadros LG, Kaiser RL, Campos JM, Zotarelli IJ, et al. Argon plasma effect about anastomosis was significant to inhibit the weight regained in patients undergoing gastric bypass. J Obes Weight Loss Ther. 2015;5:264.CrossRefGoogle Scholar
  29. 29.
    Cambi MP, Marchesini SD, Baretta GA. Post-bariatric surgery weight regain: evaluation of nutritional profile of candidate patients for endoscopic argon plasma coagulation. Arq Bras Cir Dig. 2015;28(1):40–3.CrossRefGoogle Scholar
  30. 30.
    Brunaldi VO, Jirapynio P, Moura DTH, Okazaki O, Bernardo WM, Neto MG, et al. Endoscopic treatment of eight regain following Roux-en-Y Gastric Bypass: a systematic review and meta-analysis. Obes Surg. 2018;28(1):266–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Luiz Gustavo de Quadros
    • 1
  • Manoel Galvão Neto
    • 2
    • 3
    • 4
  • Eduardo Grecco
    • 5
  • Thiago Ferreira de Souza
    • 2
    • 4
    • 5
    • 6
  • Idiberto José Zotarelli Filho
    • 7
  • Andre Fernandes Teixeira
    • 8
  1. 1.Department of Bariatric EndoscopyKaiser Day HospitalSão José do Rio PretoBrazil
  2. 2.Faculty of Medicine of ABC – FMABCSanto AndréBrazil
  3. 3.Florida International University – FIUMiamiUSA
  4. 4.EndoVitta InstituteSão PauloBrazil
  5. 5.ABC Medical School (FMABC)São PauloBrazil
  6. 6.University of São Paulo – USPSão PauloBrazil
  7. 7.São José do Rio PretoBrazil
  8. 8.Bariatric and Laparoscopy Center, Orlando HealthOrlandoUSA

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