Efficacy of argon plasma coagulation (APC) in the reduction of gastrojejunal anastomosis for weight regain after Roux-en-Y gastric bypass.

BACKGROUND AND AIMS: argon plasma coagulation (APC) is a recognized endoscopic therapy for weight regain after Roux-en-Y gastric bypass (RYGB). This study aimed to validate its efficacy and safety in a Spanish tertiary center and to explore predictors of response.

PATIENTS AND

METHODS

a single-center retrospective study was conducted of 36 RYGB patients who underwent standardized APC for weight regain between 2018 and 2023. The primary endpoint was percentage total weight loss (%TWL) at 3, 6, and 12 months. Secondary outcomes included body mass index (BMI) change, reduction of gastrojejunal anastomosis (GJA) diameter, safety, and exploratory predictors of response. Responders were defined as patients achieving ≥ 5 %TWL at 3 months.

RESULTS

mean %TWL was ~8 % at 3, 6 and 12 months. At 12 months, 63.9 % of patients maintained ≥ 5 %TWL, 38.9 % ≥ 10 %, and 16.7 % ≥ 15 %. Early response (≥ 5 %TWL at 3 months) predicted sustained efficacy. Responders achieved significantly greater weight loss than non-responders at all time points, reaching ~11 %TWL at one year. No associations were found between %TWL and baseline demographics, comorbidities, or GJA diameter. The mean GJA reduction was 10 mm (-36.9 %), with 72 % of patients achieving a final GJA ≤ 18 mm, although this did not correlate with %TWL. Technical success was 100 %. Three adverse events (8 %), all mild, were reported.

CONCLUSIONS

APC is a safe and simple option for post-RYGB weight regain, achieving clinically meaningful weight loss in over 60 % of patients. Early response is a predictor of long-term benefit and may guide timely initiation of adjunctive therapies in non-responders.