Endoscopic Management of Weight Regain in the Bariatric Patient

Despite initial weight loss following bariatric surgery, weight recidivism is common. While weight regain is multifactorial and includes behavioral, psychosocial, and medical causes, changes in anatomy also play a role. Dilation of the gastrojejunal anastomosis following Roux-en-Y gastric bypass and enlargement of the gastric sleeve following sleeve gastrectomy are both important considerations. Historically, surgical revision has been performed to address weight regain; however, morbidity and mortality are not insignificant. Over the past decade, a variety of endoscopic approaches have been described for weight recidivism, several of which have proven to be safe, effective, and durable. This article will review each of these techniques in detail.

Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes

Purpose Many revisional procedures are available for unsuccessful laparoscopic sleeve gastrectomy (LSG) in patients with complications or weight recidivism. Single anastomosis duodeno-ileal bypass (SADI-S) and one anastomosis gastric bypass (OAGB-MGB) are two revisional procedures to address the problem of weight recidivism. We aimed to evaluate the efficacy and outcomes of the 2 revisional approaches (SADI-S vs. OAGB-MGB). Materials and Methods A retrospective analysis of prospectively collected database of patients who underwent SADI-S or OAGB-MGB as a revisional procedure for weight recidivism after primary LSG with a minimum 1-year follow-up. Weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared in the 2 procedures. Results Ninety-one patients were included in the study (42 SADI-S and 49 OAGB-MGB). There was a significant weight loss (total weight loss percentage, TWL%) at 1-year follow-up observed for SADI-S when compared to OAGB-MGB (23.7 ± 5.7 vs. 18.7 ± 8.5, p = 0.02). However, this difference was not statistically significant at 18 months (26.4 ± 7.3 vs. 21.2 ± 11.0, p = 0.25). Remission of comorbidities (diabetes mellitus and hypertension) was comparable. Although OAGB-MGB had higher complication rate than SADI-S, the difference was not statistically significant (p = 0.39). No mortality was reported in the study groups. Conclusion Both SADI-S and OAGB-MGB are effective and safe revisional procedures for weight regain after LSG. The short-term outcomes are comparable; however, SADI-S is associated with less upper gastrointestinal complications and could be a better option for patients suffering from GERD post-LSG. Moreover, the underlying bile reflux may get worse with OAGB-MGB. However, further prospective larger studies are needed.