Introduction
Obesity remains a major public health issue in developed countries. While bariatric procedures such as Roux-en-Y gastric bypass (RYGB) are effective, up to 20% of patients experience long-term weight regain. Dilation of the gastrojejunal anastomosis (GJA) may contribute to this, possibly due to faster gastric emptying. Argon plasma coagulation (APC) has been shown to reduce GJA diameter, potentially restoring satiety and promoting weight loss.
Aims & Methods
This study aimed to evaluate APC efficacy in reducing GJA diameter in patients with post-RYGB weight regain and to identify potential predictors of total weight loss (TWL).
A retrospective, single-center study included 36 RYGB patients treated with APC from 2018–2023. The primary outcome was %TWL. Secondary endpoints included reduction in anastomosis diameter (RAD), comorbidities, and adverse events (AEs). Patients were followed at 3, 6, and 12 months and categorized by TWL (≥5%, ≥10%, ≥15%). Responders were defined as those achieving ≥5% TWL at 3 months. Associations between TWL, responders to APC and demographic or clinical variables were analyzed.
Results
Total Weight Loss
Initially, all patients experienced some degree of weight loss after the APC intervention. The mean absolute TWL of 8.3%, 8%, and 8.2% at 3, 6, and 12 months.
Regarding categorical TWL, over 60% achieved ≥5% TWL throughout follow-up (Figure 1), with 61.1% at 3 months, 66.7% at 6 months, and 63.9% at 12 months. Though ≥10% and ≥15% rates were lower. No clinically significant associations were found between pre-treatment patients factors and comorbidities; and subsequent weight loss.
TWL was significantly higher in responders (14.9%, 11.7%, 11.1%) vs. non-responders (Figure 2), but no predictive baseline factors were identified (Table 1).
At 12 months (Figure 3), over 80% maintained ≥5% TWL, and more than 50% reached ≥10% . Though ≥15% was sustained in only 13.9%–16.7%, highlighting obesity’s chronic nature and APC’s limited long-term effect.
Furthermore, at 12 months, mean BMI in responders was significicantly lower (31.7kg/m2), and over a quarter (27.3%) of responders achieved a BMI <30, no longer meeting obesity criteria, which may be considered a significant clinical success.
GJA diameter
Patients presented with notably enlarged GJA diameters, with a mean pre-APC GJA of 26.61 ± 5.41 mm, and 16.4 ± 5.0 mm post-APC (p < 0.001). A small final GJA diameter (<18 mm) was achieved in 72%. The mean RAD was 10.22 ± 6.4 mm, representing a 36.9 ± 19.3% decrease. However, neither RAD nor final GJA diameter were predictive of TWL. These findings align with the hypothesis proposed by some authors, suggesting that patients with persistently larger GJA diameters (>18 mm) may benefit from alternative interventions, such as endoscopic suturing.
| Variables | Non-responders:
(TWL < 5% at 3m)
14/36 (39%) | Responders:
(TWL ≥ 5% at 3m)
22/36 (61%) | p value |
| BMI before RYGB (kg/m2) | 44.5 ± 5 | 46.2 ± 4.1 | 0.270 |
| BMI before APC (kg/m2) | 36.3 ± 5.2 | 35.9 ± 5.5 | 0.824 |
| BMI 1 year post-APC (kg/m2) | 34.8 ± 5.1 | 31.7 ± 4.1 | 0.049 |
| TWL (%) 3 months | 1.4 ± 0.02 | 14.9 ± 0.07 | 0.001 |
| TWL (%) 6 months | 5.4 ± 0.08 | 11.7 ± 0.07 | 0.008 |
| TWL (%) 12 months | 3.7 ± 0.08 | 11.1 ± 0.08 | 0.009 |
| Baseline GJA diameter (mm) | 26.5 ± 5 | 26.7 ± 5.7 | 0.923 |
| Final GJA diameter (mm) | 15.8 ± 4.8 | 16.8 ± 5.3 | 0.577 |
| RAD (%) median (IQR) | -39.3 (-50,-23) | -33.8 (-54.3, -19.2) | 0.808 |
Table 1. Variables in responders an non-responders.
Number of APC sessions, efficacy and safety
The impact of the number of APC sessions on TWL was assessed comparing patients with 1–2 sessions versus those with 3-4. Although other studies have found correlation, in our study, a weak correlation with TWL at 3 months was found with Spearman’s Rho test (ρ = 0.163).
Technical success rate was 100%. Only three mild AEs (8%) were reported: two mild stenosis that required endoscopic dilation and a GJA mild ulcer.
Conclusion
APC is a safe, non-invasive and effective option for managing weight regain after RYGB at least in the short and medium term, in 60% of patients. Despite efforts, no predictors of TWL were identified. Larger studies and a multidisciplinary approach may further improve outcomes.
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