LONG-TERM FOLLOW-UP AFTER TRANSORAL OUTLET REDUCTION FOR WEIGHT REGAIN AFTER ROUX-EN-Y GASTRIC BYPASS: BACK TO STAGE 0?
DOI: 10.1055/a-2075-1198
Please cite this article as: Brunaldi V O, de Oliveira G, Kerbage A et al. LONG-TERM FOLLOW-UP AFTER TRANSORAL OUTLET REDUCTION FOR WEIGHT REGAIN AFTER ROUX-EN-Y GASTRIC BYPASS: BACK TO STAGE 0?. Endoscopy International Open 2023. doi: 10.1055/a2075-1198
Conflict of Interest: Vitor Brunaldi: received payments for lectures and testimonials from Erbe Elektromedizin Gmbh.
Diogo T. H. de Moura: Advisory board for Bariatek Solutions.
Eduardo G. H. de Moura: Speaker for Boston Scientific and Olympus.
All other authors disclose no conflicts of interest
Trial registration: NCT03094936, ClinicalTrials.gov (http://www.clinicaltrials.gov/), Extended follow-up study for a RCT
Abstract:
Background and study aim: Significant weight regain affects up to a third of patients after Roux-en-Y Gastric Bypass (RYGB) and demands treatment. The transoral outlet reduction (TORe) with Argon Plasma Coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short. However, no study has investigated the course of the gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedural year. Patients and methods: Patients eligible for a 36-month follow-up visit after TORe underwent upper GI endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJA size. Comparisons between APC and APC-FTS TORe were a secondary aim. Results: Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to preprocedural levels. Only the energy/fatigue domain improvement was kept between the one and 3-year visits. Conclusions: Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered an iterant rather than a one-off procedure.
Corresponding Author:
Dr. Vitor O Brunaldi, Universidade de Sao Paulo Faculdade de Medicina, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil, vbrunaldi@gmail.com, vbrunaldi@hotmail.com
Affiliations:
Vitor O Brunaldi, Universidade de Sao Paulo Faculdade de Medicina, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
Vitor O Brunaldi, Mayo Clinic, Gastroenterology and Hepatology Department, Rochester, United States
Guilherme Henrique Peixoto de Oliveira, University of Sao Paulo, Gastroenterology, Sao Paulo, Brazil
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Submission Date: 2023-02-17
Accepted Date: 2023-04-14
Accepted Manuscript online: 2023-04-17