Dose response for argon plasma coagulation in the treatment of weight regain after Roux-en-Y gastric bypass

Abstract

Argon plasma coagulation (APC) of gastrojejunal anastomosis (GJA) is effective in treating weight regain after Roux-en-Y gastric bypass (RYGB). This study aims to compare the efficacy of different APC settings for treating weight regain. This was a single-center retrospective study of patients who had undergone RYGB and then underwent APC from 2014 to 2018 for weight regain. Patients receiving only low-dose APC (45-55 W) or high-dose APC (70-80 W) were compared. The primary outcome was the difference in percentage total weight loss (% TWL) between the groups at 6 and 12 months after the last treatment. Secondary outcomes were technical success, adverse events (AEs), and predictors of weight loss at 12 months. Two hundred seventeen patients met the inclusion criteria and underwent 411 APC sessions. Of these, 116 (53.5%) patients underwent 267 low-dose APC sessions (2.4 ± 1.5 sessions/patient) and 101 (46.5%) patients underwent 144 high-dose APC sessions (1.4 ± 0.7 sessions/patient). Follow-up rates were 82.9% and 75.3% at 6 and 12 months. At 6 months, the low- and high-dose groups experienced 7.3% ± 6.6% and 8.1% ± 7.4% TWL, respectively (P= .41). At 12 months, the low- and high-dose groups experienced 5.1% ± 8.5% and 9.7% ± 10.0% TWL, respectively (P= .008). Technical success was 100%. The overall AE rate was 8.0%; the most common AE was GJA stenosis (4.6%). The GJA stenosis rate was similar for the low- and high-dose groups (3.0% vs 7.6%, P= .06). High-dose APC remained a significant predictor of greater weight loss at 1 year after controlling for confounders. APC is effective at treating weight regain after RYGB, and higher-watt APC was associated with greater weight loss.