Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures

Background Weight regain after Roux-en-Y gastric bypass (RYGB) is common. Endoscopic sclerotherapy is increasingly used to treat this weight regain. Objectives To report safety, outcomes, durability, and predictors of response to sclerotherapy in a large prospective cohort. Design Retrospective anal...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2012-08, Vol.76 (2), p.275-282
Main Authors: Abu Dayyeh, Barham K., MD, MPH, Jirapinyo, Pichamol, BA, Weitzner, Zachary, Barker, Charlotte, Flicker, Michael S., MD, Lautz, David B., MD, Thompson, Christopher C., MD, MSc, FACG, FASGE
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Gastric Bypass
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Gastroscopy
Humans
Kaplan-Meier Estimate
Linear Models
Male
Medical sciences
Middle Aged
Multivariate Analysis
Obesity, Morbid - surgery
Obesity, Morbid - therapy
Retrospective Studies
Sclerosing Solutions - therapeutic use
Sclerotherapy - adverse effects
Sclerotherapy - methods
Sodium Morrhuate - therapeutic use
Time Factors
Treatment Failure
Treatment Outcome
Weight Gain
Weight Loss
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Summary:Background Weight regain after Roux-en-Y gastric bypass (RYGB) is common. Endoscopic sclerotherapy is increasingly used to treat this weight regain. Objectives To report safety, outcomes, durability, and predictors of response to sclerotherapy in a large prospective cohort. Design Retrospective analysis of a prospective cohort study of patients with weight regain after RYGB. Patients A total of 231 consecutive patients undergoing 575 sclerotherapy procedures between September 2008 and 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-Meier survival analysis and log-rank test to compare time to continuation of weight regain after sclerotherapy in patients undergoing a single versus multiple sclerotherapy procedures. Results At 6 and 12 months from the 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 = .003). The average weight loss at 6 months from the last sclerotherapy session for the entire cohort was 10 lb (standard deviation 16), representing 18% of the weight regained after RYGB. A subset of 73 patients (32% of the cohort) had greater weight loss at 6 months (26 lb, standard deviation 12), representing 61% of the weight regained. Predictors of a favorable outcome included greater weight regain and the number of sclerotherapy procedures. Bleeding was reported in 2.4% of procedures and transient diastolic blood pressure increases in 15%, without adverse health outcomes. No GI perforations were reported. Conclusions Endoscopic sclerotherapy appears to be a safe and effective tool for the management of weight regain after RYGB.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2012.03.1407