title: Endoluminal revision of gastric bypass for weight regain--a systematic review.
abstract: BACKGROUND
  Weight recidivism after Roux-en-Y gastric bypass (RYGB) is a challenging problem for patients and bariatric surgeons alike. Traditional operative strategies to combat weight regain are technically challenging and associated with a high morbidity rate. Endoluminal interventions are thus an attractive alternative that may offer a good combination of results coupled with lower periprocedure risk that might one day provide a solution to this increasingly prevalent problem. The purpose of this article is to systematically review the available literature on endoluminal procedures used to address weight regain after RYGB, with specific attention to the safety profile, efficacy, cost, and current availability. This review focuses only on endoluminal procedures that are performed for weight regain after RYGB, as opposed to primary endoluminal obesity procedures.
  
  
  METHODS
  This study was a retrospective review.
  
  
  RESULTS
  Several methods of endoluminal intervention for weight regain are reviewed, ranging from injection of inert substances to suturing and clipping devices. The literature review shows the procedures on the whole to be well tolerated with limited efficacy. The majority of the literature is limited to small case series. Most of the reviewed devices are no longer commercially available.
  
  
  CONCLUSIONS
  Endoluminal therapy represents an intriguing strategy for weight regain after RYGB. However, the current and future technologies must be rigorously studied and improved such that they offer durable, repeatable, cost-effective solutions.
authors.affiliation: Weill Cornell Medical College, New York, NY 10065, USA. grd9006@med.cornell.edu
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Dakin
authors.forename: George
authors.initials: G
authors.lastname: Eid
authors.forename: Dean
authors.initials: D
authors.lastname: Mikami
authors.forename: Aurora
authors.initials: A
authors.lastname: Pryor
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
mesh_terms: D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods*; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000379:methods; D013525:Surgical Instruments; D013536:Suture Techniques; D015430:Weight Gain / Q000502:physiology