Argon plasma coagulation alone versus endoscopic suturing plus argon plasma coagulation to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos)

Abstract Background and Aims A significant portion of patients regain weight after Roux-en-Y gastric bypass (RYGB). Both ablation with argon plasma coagulation (APC) plus endoscopic full-thickness suturing (FTS-APC) and ablation alone have been reported at treating weight regain when associated with gastrojejunostomy (GJ) dilation. However, comparative controlled data are still lacking. Methods This was a pilot single-center open-label randomized trial comparing the effectiveness and safety of APC alone versus FTS-APC in performing transoral outlet reduction. Patients with at least 20% weight regain from the nadir, and GJ ≥15 mm were considered eligible. The primary outcome was % total weight loss (%TWL) at 12 months. Secondary outcomes were the incidence of adverse events, amelioration of metabolic laboratory parameters, and improvement in quality of life (QOL) and eating behavior. Results Forty patients meeting eligibility criteria were enrolled from October 2017 to July 2018. Technical and clinical success rates were similar between groups. At 12 months, the mean %TWL was 8.3 ± 5.5 in the APC alone group versus 7.5 ± 7.7% in the FTS-APC group (p=0.71). The prerevisional % solid gastric retention at 1 hour positively correlated with the probability of achieving ≥10% TWL at 12 months. Both groups experienced significant reductions in LDL and triglycerides levels at 12 months, and improvement in eating behavior and QOL at 3 months. There were 2 cases of stenoses (one from each group) successfully treated with endoscopic balloon dilation. Conclusion The APC alone is similar to the FTS-APC in terms of technical and clinical outcomes within 1 year of follow-up.