Endoscopic strategies for management weight regain after Roux-en-Y gastric bypass: a narrative review

Purpose: Bariatric surgery is a surgical procedure and an effective option for the treatment of severe obesity. The Roux-en-Y gastric bypass is the second-most-performed gastric intervention worldwide. Despite the efficacy of Roux-en-Y gastric bypass for the treatment of obesity, weight regain is a common long-term complication of Roux-en-Y gastric bypass. Weight regain after Roux-en-Y gastric bypass can be managed by reintroducing the patient to a multidisciplinary team, behavioral changes, revisional surgery, and endoscopic procedures. Methods: This review will discuss the new effective methods, primarily endoscopic procedures, for weight regain post-Roux-en-Y gastric bypass. Results and conclusion: The etiology of weight regain tends to be multifactorial. Lifestyle behavior modification is an important target for post-bariatric surgery weight regain. Revisional surgery options include improvement of restriction or intensification of malabsorption. Endoscopic procedures have been designed to reduce the diameter of the gastrojejunal anastomosis (GJA). Endoluminal techniques for reducing pouch and stoma size to address weight regain have the potential to improve restriction with lower morbidity. Endoluminal revision procedures can be conducted in various forms, including sclerotherapy, endoluminal suturing, tissue plication, argon plasma coagulation, and mixed. It is necessary to consider the individuality of the patient to choose the best strategy and/or endoscopic procedure for the management of weight loss in patients with weight regain after Roux-en-Y gastric bypass. Studies are needed to monitor the performance of GJA diameter and long-term weight loss for an individualized treatment approach and cost-effectiveness.