Endoscopic management of weight regain following Roux-en-Y gastric bypass

ABSTRACT

Introduction: With the cumulative increase in the number of patients undergoing bariatric surgery, postoperative weight regain has become a considerable challenge. Mechanisms for weight regain are not fully understood and the process is likely multifactorial in many cases. Endoluminal revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective and less invasive management strategy for this population.

Areas covered: We critically review data from case series, retrospective and prospective studies, and meta-analyses pertaining to weight regain after gastric bypass. A variety of endoscopic revision approaches are reviewed, including technique details, procedural safety and efficacy, and post-procedure care.

Expert commentary: Given the proliferation of endoluminal therapies with evidence showing safety and efficacy in the treatment of weight regain, it is likely that endoscopic revision will be the gold standard to treat weight regain in patients with gastric bypass.

KEYWORDS:

• Bariatric
• endoscopy
• surgery
• obesity
• weight regain
• sclerotherapy
• endoscopic
• gastric plication
• transoral
• endoluminal

Acknowledgments

The authors thank Vitor O. Brunaldi and Gustavo L. Rodela for the artistic drawings.

Declaration of interest

CC Thompson is a consultant to Apollo Endosurgery, USGI Medical, and Olympus. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.