Background Weight regain after Roux-en-Y gastric bypass (RYGB) is common. Endoscopic sclerotherapy is increasingly used for treatment of this weight regain. Objectives To report safety, outcomes, durability, and predictors of response to sclerotherapy from a large prospective cohort. Design Retrospective analysis of prospective cohort study of patients with weight regain after RYGB. Patients 231 consecutive patients undergoing 575 sclerotherapy procedures between September 2008 – March 2011. Interventions Single or multiple sclerotherapy procedures to inject sodium morrhuate into the rim of the gastrojejunal anastomosis. Main outcome measurements We report weight loss, complications, and predictors of response. We also used Kaplan-Meir survival analysis and log-rank test to compare time to continuation of weight regain after sclerotherapy between patients undergoing a single vs. multiple sclerotherapy procedures. Results At 6 and 12 months from last sclerotherapy procedure weight regain stabilized in 92% and 78% of the cohort, respectively. Those who underwent 2 or 3 sclerotherapy sessions had significantly higher rates of weight regain stabilization than those who underwent a single session (90% vs. 60% at 12 months) (p= 0.003). The average weight loss at 6 months from last sclerotherapy session for the entire cohort was (10 lb, SD 16) representing 18% of the weight regained after RYGB. A subset of 73 patients (32% of the cohort) had higher weight loss at 6 months (26 lb, SD 12) representing 61% of the weight regained. Predictors of favorable outcome included higher magnitude of weight regain and number of sclerotherapy procedures. Bleeding was reported in 2.4% of procedures and transient diastolic blood pressure elevations in 15%, without adverse health outcomes. No gastrointestinal perforations were reported. Conclusions Endoscopic sclerotherapy appears to be a safe and effective tool for the management of weight regain after RYGB.

A mixed (screening and nonscreening) CTC population has a low prevalence of high-risk lesions, and the additional cost of their evaluation is relatively small.

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