title: Weight regain following RYGB can be effectively treated using a combination of endoscopic suturing and sclerotherapy.
abstract: Obesity is a leading cause of morbidity and healthcare utilization. At the moment, the best treatment for obesity has shown to be laparoscopic gastric bypass. However, about a quarter of the patients experience substantial weight regain, which is difficult to treat, as revision surgery has higher risks than primary procedures. Endoscopic procedures, such as endoscopic suturing, are effective, safe and less invasive in addressing weight regain.
  
  
  
  We conducted a retrospective analysis on 22 consecutive patients operated between 2011 and 2013 who had a significant weight regain after RYGB (mean follow-up 22 months), in order to evaluate the long-term outcomes of endoscopic gastro-jejunal revision after weight regain post-bypass surgery. Mucosal ablation around the anastomosis was performed in all patients, and the endoscopic suturing device was used to perform suture stoma reduction. We also evaluated, in a group of 11 patients, the effect of combining sclerotherapy and endoscopic suturing.
  
  
  
  We showed good efficacy of the endoluminal procedure, with 100 % of patients achieving weight loss. Maximum weight loss was noted at a mean of 18-month follow-up (average of 60.3 % excess weight loss; n = 19), while the mean weight loss regained percentage was 5 % ± 39. 4/22 patients (all four in non-sclerotherapy group, all of them had an anastomosis >10 mm) regained some of this lost weight by the time of the longest follow-up. There was an actual correlation between final stoma diameter (<10 mm) and weight loss.
  
  
  
  A larger randomized sample of patients with a longer follow-up would be needed to support the effectiveness of the combination of the two therapies. Although almost 20 % of the patients regained weight during the follow-up period, the endoluminal approach offers the advantage of being repeatable after weight regain without adding morbidity risks.
authors.affiliation: IRCAD - IHU Strasbourg, Institute of Image-Guided Surgery, S/c IRCAD 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. pietrof.riva@gmail.com.
authors.forename: Pietro
authors.identifier: 0000-0001-6451-3153
authors.initials: P
authors.lastname: Riva
authors.affiliation: IRCAD - IHU Strasbourg, Institute of Image-Guided Surgery, S/c IRCAD 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.|Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Silvana
authors.initials: S
authors.lastname: Perretta
authors.affiliation: IRCAD - IHU Strasbourg, Institute of Image-Guided Surgery, S/c IRCAD 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.|Nouvel Hôpital Civil, Strasbourg, France.|Foundation for Surgical Innovation and Education, Portland, OR, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Swanstrom
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery* / Q000628:therapy; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D015911:Sclerotherapy; D013536:Suture Techniques; D017211:Treatment Failure; D015430:Weight Gain; D015431:Weight Loss
keywords: Anastomosis revision; Endoscopic suturing; Failed bariatric surgery; Obesity