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. 2020 Jun;34(6):2410-2428.
doi: 10.1007/s00464-020-07468-w. Epub 2020 Feb 28.

The use of endoluminal techniques in the revision of primary bariatric surgery procedures: a systematic review

Yan Mei Goh  1   2 , Nicole Ellen James  3 , En Lin Goh  3   4 , Achal Khanna  5
Affiliations

The use of endoluminal techniques in the revision of primary bariatric surgery procedures: a systematic review

Yan Mei Goh et al. Surg Endosc. 2020 Jun.

Erratum in

Abstract

Background: Weight regain following primary bariatric surgery is attributed to anatomical, behavioural and hormonal factors. Dilation of the gastrojejunal anastomosis is a possible cause of weight regain after roux-en-Y gastric bypass (RYGB). However, surgical revision has significant risks with limited benefits. Endoluminal procedures have been suggested to manage weight regain post-surgery. This systematic review aims to assess efficacy of endoluminal procedures.

Methods: Studies where endoluminal procedures were performed following primary bariatric surgery were identified. Main outcome measures were mean weight loss pre- and post-procedure, excess weight loss, recurrence rates, success rates and post-procedure complications.

Results: Twenty-six studies were included in this review. Procedures identified were (i) endoluminal plication devices (ii) other techniques e.g. sclerotherapy, mucosal ablation, and Argon Plasma Coagulation (APC) and (iii) combination therapy involving sclerotherapy/mucosal ablation/APC and endoscopic OverStitch device. Endoluminal plication devices show greatest initial weight loss within 12 months post-procedure, but not sustained at 18 months. Only one study utilising sclerotherapy showed greater sustained weight loss with peak EWL (19.9%) at 18 months follow-up. Combination therapy showed the greatest sustained EWL (36.4%) at 18 months. Endoluminal plication devices were more successfully performed in 91.8% of patients and had lower recurrence rates (5.02%) compared to sclerotherapy and APC, with 46.8% success and 21.5% recurrence rates. Both procedures demonstrate no major complications and low rates of moderate complications. Only mild complications were noted for combination therapy.

Conclusions: The paucity of good quality data limits our ability to demonstrate and support the long-term efficacy of endoluminal techniques in the management of weight regain following primary bariatric surgery. Future work is necessary to not only clarify the role of endoluminal plication devices, but also combination therapy in the management of weight regain following primary bariatric surgery.

Keywords: Bariatric surgery; Endoluminal techniques; Revision surgery.

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Conflict of interest statement

Miss Yan Mei Goh, Nicole Ellen James, En Lin Goh, and Achal Khanna have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
PRISMA chart of the study selection process
Fig. 2
Fig. 2
Graph demonstrating percentage EWL over time in endoluminal plication devices and others (sclerotherapy and APC)
See this image and copyright information in PMC

References

    1. English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM. American Society for metabolic and bariatric surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14:259–263. - PubMed
    1. Brolin RE, Kenler HA, Gorman JH, Cody RP. Long-limb gastric bypass in the superobese: a prospective randomized study. Ann Surg. 1992;215(4):387–395. - PMC - PubMed
    1. Capella JF, Capella RF. The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass? Am J Surg. 1996;171(1):74–79. - PubMed
    1. Fobi MAL, Lee H, Igwe D, Felahy B, James E, Stanczyk M, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11(2):190–195. - PubMed
    1. Capella JF, Capella RF. The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass? Am J Surg. 1996;1:74–79. - PubMed

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