Endoscopic therapy of weight regain after bariatric surgery

doi:10.4240/wjgs.v13.i12.1584

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. Dec 27, 2021; 13(12): 1584-1596
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1584

Endoscopic therapy of weight regain after bariatric surgery

Milutin Bulajic, Salvatore Francesco Vadalà di Prampero, Ivo Boškoski, Guido Costamagna

Milutin Bulajic, Salvatore Francesco Vadalà di Prampero, Department of Gastroenterology and Digestive Endoscopy, Mater Olbia Hospital, Olbia 07026, Italy

Ivo Boškoski, Guido Costamagna, Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy

Author contributions: Bulajic M and Vadalà di Prampero SF performed the study conceptualized the study and wrote and edited the paper; Boškoski I and Costamagna G reviewed and edited the paper; All authors have read and approve the final manuscript.

Conflict-of-interest statement: Dr Ivo Boskoski is a consultant for Apollo Endosurgery, Boston Scientific, research grant holder from Apollo Endosurgery, Scientific Board member EndoTools. Dr Guido Costamagna is a consultant for Cook Medical, Boston Scientific and Olympus.

Corresponding author: Milutin Bulajic, FACG, FASGE, MD, PhD, Chief Doctor, Department of Gastroenterology and Digestive Endoscopy, Mater Olbia Hospital, Strada Statale 125 Orientale Sarda, Olbia 07026, Italy. milutin.bulajic@materolbia.com

Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: February 28, 2021
Revised: March 14, 2021
Accepted: August 2, 2021
Article in press: August 2, 2021
Published online: December 27, 2021
Processing time: 317 Days and 12.7 Hours

Abstract

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

Keywords: Morbid obesity; Weight regain; Endoscopic sleeve gastroplasty; Transoral outlet reduction; Bariatric surgery; Full thickness suturing

Core Tip: Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective and less invasive treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery.