Revision strategies for weight regain or insufficient weight loss after Roux-en-Y gastric bypass
A systematic review and meta-analysis
EAES Academy. Franken R. 07/05/22; 366535; P278
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Abstract
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Objective
The aim of this meta-analysis was to assess revision intervention strategies for weight regain or insufficient weight loss following RYGB.
Background
Weight failure after RYGB is a major therapeutic challenge. However, a consensus on the most effective treatment is lacking.
Methods
A literature search (in PubMed and Embase) of revision interventions after RYGB was performed through September 2021. Measured outcomes included BMI at intervention, BMI/ TWL during follow-up, and complications. Random effects models were used to determine pooled effect size and corresponding 95% CIs.
Results:
33 studies (n=2533) were included. Fifteen studies reported on endoscopic interventions: three on APC, four on TORe, and eight on TORe + APC. After one year follow-up, pooled TWL was 7.61 kg (95% CI, 6.40 – 8.82), 5.27 kg (95% CI, 1.52 – 9.03), and 7.61 kg (95% CI, 6.08 – 9.14), respectively. Eighteen studies reported on surgical interventions (figure 1): four on pouch/GJA revision, five on LGB, two on pouch LGB + pouch resizing, seven on D-RYGB and one on DS. After one year follow-up, pooled BMI reduction was 6.44 kg/m2 (95% CI, 3.94 – 8.94), 5.17 kg/m2 (95% CI, 1.44 – 8.9), 8.5 kg/m2 (95% CI, 5.29 – 11.71), 8.44 kg/m2 (95% CI, 5.46 – 11.42), and 9.3 kg/m2 (95% CI, 6.05 – 12.55), respectively. Complications for surgical interventions were high compared to those for endoscopic interventions.
Conclusion
All techniques resulted in short-term clinically relevant weight loss. Endoscopic procedures resulted in modest transient weight loss. Other surgical revision techniques were successful in longer term follow-up, at the expense of high complication rates.
The aim of this meta-analysis was to assess revision intervention strategies for weight regain or insufficient weight loss following RYGB.
Background
Weight failure after RYGB is a major therapeutic challenge. However, a consensus on the most effective treatment is lacking.
Methods
A literature search (in PubMed and Embase) of revision interventions after RYGB was performed through September 2021. Measured outcomes included BMI at intervention, BMI/ TWL during follow-up, and complications. Random effects models were used to determine pooled effect size and corresponding 95% CIs.
Results:
33 studies (n=2533) were included. Fifteen studies reported on endoscopic interventions: three on APC, four on TORe, and eight on TORe + APC. After one year follow-up, pooled TWL was 7.61 kg (95% CI, 6.40 – 8.82), 5.27 kg (95% CI, 1.52 – 9.03), and 7.61 kg (95% CI, 6.08 – 9.14), respectively. Eighteen studies reported on surgical interventions (figure 1): four on pouch/GJA revision, five on LGB, two on pouch LGB + pouch resizing, seven on D-RYGB and one on DS. After one year follow-up, pooled BMI reduction was 6.44 kg/m2 (95% CI, 3.94 – 8.94), 5.17 kg/m2 (95% CI, 1.44 – 8.9), 8.5 kg/m2 (95% CI, 5.29 – 11.71), 8.44 kg/m2 (95% CI, 5.46 – 11.42), and 9.3 kg/m2 (95% CI, 6.05 – 12.55), respectively. Complications for surgical interventions were high compared to those for endoscopic interventions.
Conclusion
All techniques resulted in short-term clinically relevant weight loss. Endoscopic procedures resulted in modest transient weight loss. Other surgical revision techniques were successful in longer term follow-up, at the expense of high complication rates.
Objective
The aim of this meta-analysis was to assess revision intervention strategies for weight regain or insufficient weight loss following RYGB.
Background
Weight failure after RYGB is a major therapeutic challenge. However, a consensus on the most effective treatment is lacking.
Methods
A literature search (in PubMed and Embase) of revision interventions after RYGB was performed through September 2021. Measured outcomes included BMI at intervention, BMI/ TWL during follow-up, and complications. Random effects models were used to determine pooled effect size and corresponding 95% CIs.
Results:
33 studies (n=2533) were included. Fifteen studies reported on endoscopic interventions: three on APC, four on TORe, and eight on TORe + APC. After one year follow-up, pooled TWL was 7.61 kg (95% CI, 6.40 – 8.82), 5.27 kg (95% CI, 1.52 – 9.03), and 7.61 kg (95% CI, 6.08 – 9.14), respectively. Eighteen studies reported on surgical interventions (figure 1): four on pouch/GJA revision, five on LGB, two on pouch LGB + pouch resizing, seven on D-RYGB and one on DS. After one year follow-up, pooled BMI reduction was 6.44 kg/m2 (95% CI, 3.94 – 8.94), 5.17 kg/m2 (95% CI, 1.44 – 8.9), 8.5 kg/m2 (95% CI, 5.29 – 11.71), 8.44 kg/m2 (95% CI, 5.46 – 11.42), and 9.3 kg/m2 (95% CI, 6.05 – 12.55), respectively. Complications for surgical interventions were high compared to those for endoscopic interventions.
Conclusion
All techniques resulted in short-term clinically relevant weight loss. Endoscopic procedures resulted in modest transient weight loss. Other surgical revision techniques were successful in longer term follow-up, at the expense of high complication rates.
The aim of this meta-analysis was to assess revision intervention strategies for weight regain or insufficient weight loss following RYGB.
Background
Weight failure after RYGB is a major therapeutic challenge. However, a consensus on the most effective treatment is lacking.
Methods
A literature search (in PubMed and Embase) of revision interventions after RYGB was performed through September 2021. Measured outcomes included BMI at intervention, BMI/ TWL during follow-up, and complications. Random effects models were used to determine pooled effect size and corresponding 95% CIs.
Results:
33 studies (n=2533) were included. Fifteen studies reported on endoscopic interventions: three on APC, four on TORe, and eight on TORe + APC. After one year follow-up, pooled TWL was 7.61 kg (95% CI, 6.40 – 8.82), 5.27 kg (95% CI, 1.52 – 9.03), and 7.61 kg (95% CI, 6.08 – 9.14), respectively. Eighteen studies reported on surgical interventions (figure 1): four on pouch/GJA revision, five on LGB, two on pouch LGB + pouch resizing, seven on D-RYGB and one on DS. After one year follow-up, pooled BMI reduction was 6.44 kg/m2 (95% CI, 3.94 – 8.94), 5.17 kg/m2 (95% CI, 1.44 – 8.9), 8.5 kg/m2 (95% CI, 5.29 – 11.71), 8.44 kg/m2 (95% CI, 5.46 – 11.42), and 9.3 kg/m2 (95% CI, 6.05 – 12.55), respectively. Complications for surgical interventions were high compared to those for endoscopic interventions.
Conclusion
All techniques resulted in short-term clinically relevant weight loss. Endoscopic procedures resulted in modest transient weight loss. Other surgical revision techniques were successful in longer term follow-up, at the expense of high complication rates.
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