Background

There are multiple factors that contribute to the 15-20% failure of weight loss after Roux-en-y gastric bypass (RYGB) procedure. Among these factors, progressive dilation of gastrojejunal anastomoses has shown to be a significant component. Our study illustrates the safety and effectiveness of argon plasma coagulation (APC) at gastrojejunal anastomoses in weight loss.

Methods

This is retrospective study of 144 patients who underwent endoscopic APC procedure after failing to lose weight from RYGB. Weight and safety were studied from procedure to one month and from one month to six months.

Results

Among 144 patients, 134 resulted in weight loss from APC. The mean result in 1 month follow up was a decrease of 1.8 BMI (range -7.4 to +6.4) and 4.9-kg weight loss (range -20.8 to +14.1-kg). Among the 86 patients who did not undergo revision surgery or were not lost in follow up, 75 patients showed weight loss in 6 month follow up. There was average decrease of 4.4 BMI (range -19.6 to +5.9) and 12.3-kg weight loss (range -56.8 to +18.6-kg). Of 144 patients, 35 patients showed exceptional results; >5 BMI decrease and >25-kg weight loss. Five patients had complications; four experienced food intolerance, one of which underwent endoscopic dilation. One patient had postoperative aspiration pneumonia.

Conclusions

This study demonstrated the safety and effectiveness of APC with selected patients which showed tremendous benefit. Considering low complication, time and cost effectiveness, APC can be utilized as an adjunct procedure for patients who failed to lose weight after RYGB.