title: Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass.
abstract: BACKGROUND
  The failure of approximately 20 % of obese patients who undergo Roux-en-Y gastric bypass (RYGB) to maintain weight loss over the following 18-24 months is related to the surgical procedure, to the patient, or both. Although the underlying mechanisms are uncertain, one factor that has been postulated is the dilation of the gastrojejunal anastomosis. The objective was to evaluate the safety and efficacy of the serial use of argon plasma coagulation (APC) in reducing the diameter of the dilated gastrojejunal anastomosis and post-RYGB weight regain.
  
  
  METHODS
  We carried out a prospective, nonrandomized study of 30 patients, with no control or sham group, monitoring RYGB weight regain associated with dilation of the gastrojejunal anastomosis over a postoperative period of 18 months. Each patient underwent three sessions of APC in the anastomosis separated by 8 weeks, with a final endoscopic examination 8 weeks after the last session.
  
  
  RESULTS
  There was a loss of 15.48 kg (range = 8.0-16.0 kg) of the 19.6 kg (range = 7.0-39.0 kg) of regained weight after RYGB and a reduction of 66.89 % in the final anastomotic diameter, with statistically significant reductions between each APC session. Previous body mass index significantly decreased up to the final examination, and the final weight was close to but not at the same level as the nadir.
  
  
  CONCLUSIONS
  Our study indicates that the use of APC to treat weight regain after RYGB is a safe and effective procedure and promotes a reduction in gastrojejunal anastomosis, final weight, and BMI, with a low rate of complications.
authors.affiliation: Universidade Federal do Paraná, 1375 Alameda Presidente Taunay, 80430-000, Curitiba, PR, Brazil, giorgio.baretta@gmail.com.
authors.forename: Giorgio A P
authors.initials: GA
authors.lastname: Baretta
authors.forename: Helga C A W
authors.initials: HC
authors.lastname: Alhinho
authors.forename: Jorge Eduardo F
authors.initials: JE
authors.lastname: Matias
authors.forename: João Batista
authors.initials: JB
authors.lastname: Marchesini
authors.forename: João Henrique F
authors.initials: JH
authors.lastname: de Lima
authors.forename: Celso
authors.initials: C
authors.lastname: Empinotti
authors.forename: Josemberg M
authors.initials: JM
authors.lastname: Campos
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D057908:Argon Plasma Coagulation / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D004108:Dilatation, Pathologic / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome; D015430:Weight Gain; D055815:Young Adult