Endocrine Abstracts

Background: Dumping syndrome (DS) and post-bariatric hypoglycemia (PBH) are some of the most challenging problems encountered during the follow-up of bariatric surgery (BS), especially after Roux-en-y gastric bypass (yRGB). When pharmacological and dietary treatment fail to control DS and PBH, surgical revision is often the next therapeutic step. Endoscopic treatment with argon plasma coagulation (APC) may be an alternative treatment by reducing the diameter of the gastro-jejunal anastomosis and thus slowing gastric emptying.

Objectives: To evaluate the efficacy and safety of endoscopic APC treatment in patients who have undergone yRGB and developed DS and PBH.

Material and methods: Retrospective study of patients who underwent endoscopic gastro-jejunal anastomotic reduction using APC at 1.9 liters/min flow and 90 watts in our center between 2018-2022 to treat refractory DS and PBH following yRGB. Improvement of DS symptoms according to Sigstad score, reduction of PBH with disappearance of Whipple’s triad and anthropometric data were evaluated. Statistics: Descriptive analysis and comparison of means (t-Sudent or U-Mann-Whitney) was carried out, cording to the normality distribution of variables.

Results: 25 consecutive patients aged 52.3±9.2 years were recruited. Pre-surgery BMI was 42.7±5.5 kg/m²; nadir BMI was 26.6±3.8 and BMI before APC was 30.8±6.3. Dumping symptoms appeared 26 (20-84) months after BS. Most patients received dietary (fractionated food, low-GI carbohydrates) and pharmacological treatment (acarbose, iSGLT1/2, octreotide). All patients had an average of 2 APC endoscopic procedures (range 1-4), initial gastro-jejunal anastomosis diameter of 26.8±7.2 mm and final diameter after APC of 16.4±4.4 mm. Adverse events were mild and did not require hospitalization: pain (n=3 (12%), vomiting (n=2 (8%), ulcer (n=3 (12%), bleeding (n=1 (4%), stenosis (n=3 (12%). Symptoms improved in 100% of patients with a decrease in Sigstad score from 6.8±2.6 to 0.9±2 points and the resolution of all PBH (P<0.0001). 84% of patients were able to discontinue pharmacological treatment. In addition, 80% of patients had a significant weight loss (%BW) (P<0.01) after APC during the 2-year follow-up: 7.6±5.2% (6 months), 8.9±4.8% (12 months), 6.6±5.6% (18 months) and 5.3±5.01% (24 months).

Conclusions: Endoscopic APC is an effective, safe and reproducible procedure for the management of DS and PBH in patients with prior yRGB who are refractory to dietary and pharmacological treatment, or even as a single first-line therapy. It also contributes to weight loss after weight regain in BS.