Sa1937 ENDOSCOPIC GASTRIC PLICATION FOR THE TREATMENT OF WEIGHT REGAIN FOLLOWING ROUX-EN-Y GASTRIC BYPASS

Abstract

Gastric Plication (GP) involves inverting the stomach with tissue anchor placement to achieve serosa to serosa apposition and permanent gastric remodeling that is challenging to achieve with endoscopic suturing. One potential application of GP is the treatment of weight regain following Roux-en-Y gastric bypass (RYGB) by placing plications around the gastrojejunal anastomosis (GJA) and in the pouch to reduce their sizes. To assess technical feasibility, safety and efficacy of GP at treating weight regain following RYGB. This was a prospective registry study of RYGB patients who underwent GP for weight regain. The GJA was ablated with argon plasma coagulation (APC) (forced, 0.8 L/min, 70-80 watts). Plications were then placed in the ablated area and in the pouch (Figure 1). Technical success, clinical success defined as achievement of at least 5% total weight loss (TWL) at 1 year, and adverse events (AEs) classified using the ASGE lexicon were reported. Additionally, the amount of weight loss, reported using %TWL, at 1 and 2 years was determined. 44 RYGB patients (41F, age 50±11) underwent GP for weight regain and were included. Average BMI and weight regain were 38.8±7.9 kg/m2 and 41.7±28.6% of the maximal weight loss. Pre-GP GJA and pouch sizes were 17±7 mm and 5±2 cm, respectively. Technical success rate was 100%. Average procedure time was 66±20 minutes. APC around the GJA was performed in all patients (100%) prior to plication placement (40.9% with 80 watts, 59.1% with 70 watts). The total number of plications per case was 6±3, with 3±2 and 3±2 being placed in the GJA and pouch, respectively. Clinical success rate was 79.3%. At 1 and 2 years, patients experienced 10.3±7.4% and 8.4±12.6% TWL, respectively (p=0.01 for both). Overall AE rate was 15.9%. These included GJA stenosis (13.6%) and epigastric pain due to GJA ulceration at the APC site (2.3%). All stenoses occurred with 80 watt APC and were successfully treated with endoscopic balloon dilation without or with lumen-apposing metal stent. The severe AE rate was 0%. This novel gastric plication procedure appears feasible and safe, with a high response rate and durable weight loss at two years, for the treatment of weight regain following RYGB.