Increased Gastric Retention Capacity, Assessed by Scintigraphy, after APC Treatment of Dilated Gastrojejunal Anastomosis

Abstract

Background: Weight regain occurs in about 20% of patients after Roux-en-Y gastric bypass (RYGB). Studies have reported that in most cases this regain is associated with dilatation of the gastrojejunal anastomosis. To correct this dilatation, one of the methods used is the application of argon plasma coagulation (APC). Case: The authors report the case of a 39-year-old woman submitted to RYGB who had weight regain. In the endoscopic evaluation, the patient presented with dilatation of the gastrojejunal anastomosis, for which treatment with APC and an adjusted diet was proposed. After 3 sessions of APC, the patient presented with a reduction of the anastomosis diameter, weight loss, and increased satiety to food, with an increased gastric emptying time evidenced by scintigraphy. Conclusion: APC proved to be a safe and efficacious method.

Endoscopic transoral outlet reduction induces enterohormonal changes in patients with weight regain after Roux-en-Y gastric bypass

“…Accepted Manuscript meal termination. Also, with a reduced outlet, the food bolus leaves the pouch at a more controlled pace, [8] which justifies the reduction in GLP-1 levels after TORe. Considering the critical incretin effect of GLP-1, one should expect worsening of metabolic diseases.…”

“…[6,7] Some preliminary data suggest an increase in pouch retention may lead to enhanced satiety and better weight loss outcomes. [8] However, other studies directly contradict this finding and demonstrate a negative correlation between increased pouch retention and clinical success after TORE. [9] Gut hormones play a major role in primary weight loss after bariatric surgery and in the context of significant weight regain.…”

“…Several studies report favorable weight loss and resolution of comorbidities, but few have investigated the underlying physiology 6 7 . Some preliminary data suggest that an increase in pouch retention may lead to enhanced satiety and better weight loss outcomes 8 . However, other studies directly contradict this finding and demonstrate a negative correlation between increased pouch retention and clinical success after TORE 9 .…”

Ensaio clínico randomizado do tratamento endoscópico do reganho de peso pós derivação gástrica em Y de Roux através da moldagem da anastomose gastrojejunal com plasma de argônio isolado versus plasma de argônio associado à sutura endoscópica

“…Barrichello e cols. descreveram o aumento da saciedade associado ao prolongamento do tempo de esvaziamento gástrico em uma única paciente submetida ao tratamento com APC124 .Com o intuito de preencher estas lacunas do conhecimento, hipotetizando que os métodos APC e APC-SET seriam modalidades equivalentes, desenvolveu-se a presente tese de doutorado que consiste em um estudo comparativo, controlado, randomizado, aferindo eficácia, segurança e fatores fisiológicos relacionados ao tratamento endoscópico do reganho de peso pós-DGYR.Para inclusão, os pacientes foram encaminhados do ambulatório de reganho de peso da unidade de Cirurgia Bariátrica e Metabólica do Departamento de Gastroenterologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo ou da própria rede do Sistema Único de Saúde, sendo posteriormente matriculados no ambulatório supracitado. Por ser um serviço de referenciamento, não foi possível padronizar ou restringir a inclusão baseado na técnica empregada para realização da DGYR (pe.…”