TY - JOUR
T1 - Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass
T2 - Outcomes, complications, and predictors of response in 575 procedures
AU - Abu Dayyeh, Barham K.
AU - Jirapinyo, Pichamol
AU - Weitzner, Zachary
AU - Barker, Charlotte
AU - Flicker, Michael S.
AU - Lautz, David B.
AU - Thompson, Christopher C.
PY - 2012/8
Y1 - 2012/8
N2 - 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.
AB - 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.
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U2 - 10.1016/j.gie.2012.03.1407
DO - 10.1016/j.gie.2012.03.1407
M3 - Article
C2 - 22817783
AN - SCOPUS:84864140620
SN - 0016-5107
VL - 76
SP - 275
EP - 282
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -