scholarly journals Endoscopic plasma argon coagulation in treatment of weight regain after bariatric surgery: what does the patient think about this?

2014 ◽  
Vol 27 (suppl 1) ◽  
pp. 47-50 ◽  
Author(s):  
Simone Dallegrave MARCHESINI ◽  
Giorgio Alfredo Pedroso BARETTA ◽  
Maria Paula Carlini CAMBI ◽  
João Batista MARCHESINI
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Multidisciplinary Team ◽  
Weight Regain ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
The Internet ◽  
Bariatric Patients ◽  
Second Chance

BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. AIM: The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. METHOD: We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. RESULTS: We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. CONCLUSION: Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known.

scholarly journals MON-LB101 5-Year Data of an Aggressive Pharmacological Approach to Moderate and Morbid Obesity: Is Prevention of Bariatric Surgery Feasible in the Long Run?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Flavio Cadegiani
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Body Weight ◽  
Weight Regain ◽  
Morbidly Obese ◽  
Biochemical Profile ◽  
Initial Weight ◽  
Initial Weight Loss

Abstract Background: Maintenance of weight loss in patients that undergo weight loss interventions is highly challenging, irrespective of the type of approach to obesity (whether surgical, pharmacological, or non-pharmacological). We proposed a protocol of an aggressive clinical treatment for obesity aiming to prevent the need of bariatric surgery, in patients unwilling to undergo this procedure, by proposing a protocol that included the combination of different anti-obesity medications and non-pharmacological modalities, for longer duration, and with an active approach to prevent weight regain. Our initial 2-year data showed that 93% (40 of 43 patients) with moderate and morbid obesity were able to avoid the need of bariatric surgery, with concomitant improvements of the biochemical profile. However, whether these patients would maintain their successful rates after five years was uncertain. Our objective is to describe the efficacy and safety of a long term (5-year data) pharmacological and multi-modal treatment for moderate and severe obesity. Methods: The 40 patients that were successful in the two-year approach in our obesity center (Corpometria Institute, Brasilia, DF, Brazil) were enrolled. A long-term anti-obesity protocol was employed, with continuous or intermittent use of anti-obesity drugs, trimestral body composition analysis, psychotherapy, visit to a nutritionist every four months, and both resistance and endurance exercises at least four times a week. Body weight (BW), total weight excess (TWE), body fat, markers of lipid and glucose metabolism, liver function, and inflammation were analyzed. Subjects that dropped out were considered as weight regain. Therapeutic success for the 5-year follow-up included as the maintenance of >20% loss of the initial BW loss, and no weight regain (or < 20% of the initial weight loss). Results: A total of 27 patients (67.5%) were able to maintain the body weight, seven dropped out, and six regained more than 20% of the initial weight loss. Of these, 21 (77.8%) had significant further increase of muscle mass and decrease of fat loss, while 17 (63.0%) had further weight loss (p < 0.05), compared to the 2-year data. Improvements on the biochemical profile persisted in all 27 patients, and had significant further improvements in 24 (88.9%) of these patients. Conclusion: The risk of weight regain five years after a weight loss treatment for obesity was significantly lower compared to previous literature, and comparable to the long-term outcomes of bariatric procedures. An aggressive, structured, and long-term clinical weight loss approach has been shown to be feasible, even for morbidly obese patients.

A298 Long-Term Weight Regain After Bariatric Surgery: Does Postoperative Percent Excess Weight Loss Matter?

2019 ◽  
Vol 15 (10) ◽  
pp. S118-S119
Author(s):  
Laura Flores ◽  
Priscila Rodrigues-Armijo ◽  
Mark Ringle ◽  
Salim Hosein ◽  
Vishal Kothari
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Excess Weight Loss ◽  
Excess Weight ◽  
Percent Excess Weight Loss

Mo2056 Therapeutic With Argon Plasma Coagulation in Roux-en-Y Anastomosis for Weight Regain After Bariatric Surgery: CASE SERIES

2016 ◽  
Vol 83 (5) ◽  
pp. AB512
Author(s):  
Thiago F. Souza ◽  
Lucas M. Marques ◽  
Felipe P. Santos ◽  
Gabriel C. Nunes ◽  
Sergio Barrichello ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Regain ◽  
Argon Plasma Coagulation ◽  
Case Series ◽  
Argon Plasma ◽  
Plasma Coagulation

scholarly journals Long-Term Weight Outcomes after Bariatric Surgery: A Single Center Saudi Arabian Cohort Experience

2021 ◽  
Vol 10 (21) ◽  
pp. 4922
Author(s):  
Assim A. Alfadda ◽  
Mohammed Y. Al-Naami ◽  
Afshan Masood ◽  
Ruba Elawad ◽  
Arthur Isnani ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Saudi Arabia ◽  
Weight Regain ◽  
Severe Obesity ◽  
Successful Outcome ◽  
Post Surgery ◽  
Weight Outcomes

Background: Obesity is considered a global chronic disease requiring weight management through lifestyle modification, pharmacotherapy, or weight loss surgery. The dramatic increase in patients with severe obesity in Saudi Arabia is paralleled with those undergoing bariatric surgery. Although known to be beneficial in the short term, the long-term impacts of surgery within this group and the sustainability of weight loss after surgery remains unclear. Objectives: We aimed to assess the long-term weight outcomes after bariatric surgery. Setting: The study was conducted at King Khalid University Hospital (KKUH), King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Methods: An observational prospective cohort study on adult patients with severe obesity undergoing bariatric surgery (sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB)) during the period between 2009 and 2015 was conducted. Weight loss patterns were evaluated pre- and post-surgery through clinical and anthropometric assessments. Absolute weight loss was determined, and outcome variables: percent excess weight loss (%EWL), percent total weight loss (%TWL), and percent weight regain (%WR), were calculated. Statistical analysis using univariate and multivariate general linear modelling was carried out. Results: A total of 91 (46 males and 45 females) patients were included in the study, with the majority belonging to the SG group. Significant weight reductions were observed at 1 and 3 years of follow-up (p < 0.001) from baseline. The %EWL and %TWL were at their maximum at 3 years (72.4% and 75.8%) and were comparable between the SG and RYGB. Decrements in %EWL and %TWL and increases in %WR were seen from 3 years onwards from bariatric surgery until the study period ended. The yearly follow-up attrition rate was 20.8% at 1 year post-surgery, 26.4% at year 2, 31.8% at year 3, 47.3% at year 4, 62.6% at year 5, and 79.1% at end of study period (at year 6). Conclusion: The major challenge to the successful outcome of bariatric surgery is in maintaining weight loss in the long-term and minimizing weight regain. Factors such as the type of surgery and gender need to be considered before and after surgery, with an emphasis on the need for long-term follow-up to enssure the optimal benefits from this intervention.

Abstract P203: Demographic Predictors of Long-term Weight Loss Beginning One-Year After Bariatric Surgery at Two Medical Centers

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Laura Rasmussen-Torvik ◽  
Abigail Baldridge ◽  
Jennifer Pacheco ◽  
Sharon Aufox ◽  
Kwang-Young Kim ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Linear Mixed Effects ◽  
Post Surgery ◽  
Percentage Weight

Objective: Existing studies of predictors of weight loss after bariatric surgery suffer from simplistic statistical methods and relatively short follow-up. We sought to determine predictors of long-term weight loss up to 9.6 years after bariatric surgery using data extracted from two electronic health records (EHR) systems and linear mixed effects models. Methods: Participants were selected from patients enrolled in the NUgene biorepository at either Northwestern Memorial HealthCare or NorthShore University HealthSystem. Individuals who had undergone Roux-en-Y gastric bypass (RNY) were identified through billing or surgical history procedure codes in the electronic health records (EHRs). All available weight measurements and dates were extracted from the EHR as well as surgery date. Sex, race/ethnicity, education, marital status, and height were taken from the NUgene intake questionnaire. SAS PROC MIXED was used to create linear mixed effects models to examine weight loss from 1- 9.6 years post-surgery. To examine overall weight loss and slope of weight regain, covariates and covariate interactions with time post-surgery were included in the mixed effects models. Results: 119 individuals from Northwestern and 43 individuals from NorthShore had undergone gastric bypass and had at least 1 weight measurement 1 year post-surgery. There were 3071 weight measurements which occurred at least 1 year post-surgery in the dataset; the median number of observations per person was 10 and the median weight loss represented by these measurements was 32.7% from pre-surgical weight. The regression model indicated that, on average, individuals experienced slight weight regain of about 0.8% of pre-surgical weight per year after their first year post-surgery. Over the 1- 10 years of follow up African Americans lost nearly 5 percentage points less weight than whites ( p =.0025) . People who were older and taller also experienced less percentage weight loss, and people with higher initial weights experienced a higher percentage weight loss (all p <.05), Older age was associated with significantly (p<0.05) slower weight regain after 1 year post-surgery. Discussion: EHR records from multiple institutions can be integrated to study outcomes after bariatric surgery. Demographic factors predict overall weight loss and a rate of weight regain after 1 year post RNY surgery. This information may be useful for both surgeons and prospective patients.

Management of Obesity

2016 ◽  
Vol 34 (35) ◽  
pp. 4295-4305 ◽  
Author(s):  
Naji Alamuddin ◽  
Zayna Bakizada ◽  
Thomas A. Wadden
Keyword(s):  
Physical Activity ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Weight Regain ◽  
Initial Weight ◽  
The Us ◽  
And Behavior

This review examines weight loss and accompanying improvements in obesity-related comorbidities produced by intensive lifestyle intervention, pharmacotherapy, and bariatric surgery. Obese individuals lose approximately 6 to 8 kg (approximately 6% to 8% of initial weight) with 6 months of participation in a high-intensity lifestyle intervention (≥ 14 treatment visits) consisting of diet, physical activity, and behavior therapy. Such losses reduce progression to type 2 diabetes in at-risk people and decrease blood pressure and triglyceride levels. All diets, regardless of macronutrient composition, can produce clinically meaningful weight loss (> 5%) if they induce a deficit ≥ 500 kcal/d. Physical activity of 150 to 180 min/wk yields modest short-term weight loss compared with diet but contributes to improvements in obesity-related conditions. Gradual weight regain is common after lifestyle intervention but can be prevented by continued participation in monthly weight loss maintenance sessions, as well as by high levels of physical activity (ie, 200 to 300 min/wk). Patients unable to reduce satisfactorily with lifestyle intervention may be candidates for pharmacotherapy, recommended as an adjunct. Five medications have been approved by the US Food and Drug Administration for chronic weight management, and each has its own risk/benefit profile. The addition of these medications to lifestyle intervention increases mean weight loss by 2.5 to 8.9 kg compared with placebo. Patients with severe obesity who are unable to reduce successfully with lifestyle intervention and pharmacotherapy are eligible for bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. The first two procedures yield long-term (≥ 3 years) reductions of ≥ 20% of initial weight that are associated with decreases in morbidity and potentially mortality. Greater resources and dissemination efforts are needed to increase the availability of these three approaches for the millions of Americans who would benefit from them.

scholarly journals Efficacy of Liraglutide 3.0 Mg Treatment on Weight-Loss in Patients with Weight Regain After Bariatric Surgery

2021 ◽  
Author(s):  
Fabrizio Muratori ◽  
Federico Vignati ◽  
Gianleone Di Sacco ◽  
Lidia Gavazzi ◽  
Domenico Pellegrino ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Pharmacological Treatment ◽  
Weight Regain ◽  
Minimum Weight ◽  
Laparoscopic Gastric Banding ◽  
Real Life ◽  
Normal Weight ◽  
Serious Adverse Events

Abstract Purpose Bariatric surgery, as Roux-en-Y gastric bypass (RYGB), laparoscopic gastric banding (LGB) and laparoscopic sleeve gastrectomy (LSG), is considered the gold standard treatment to achieve long-term weight-loss in severe obesity. In patients who fail to maintain the achieved weight, pharmacological treatment may be required. Here, we reported our real-life experience on efficacy of liraglutide therapy in 62 patients who regained weight after bariatric surgery.MethodsWe retrospectively evaluated 62 (60 F-2 M; mean age: 43.6±9.9 years) patients received liraglutide for weight-loss after bariatric surgery (17 RYGB, 22 LGB and 23 LSG). Body mass index (BMI) before and after surgery was respectively of 45.4±5.5 kg/m2 and 29.5±4.9 kg/m2. Patients were followed from 2016 until 2021. Liraglutide was administered after weight regain once-daily subcutaneously at starting dose of 0.6 mg and with weekly increases up to 3.0 mg. Treatments were administered when a weight regain of 10-15% occurred after reaching a minimum weight-loss from bariatric surgery or if weight-loss after bariatric surgery was unsatisfactory. ResultsAfter a mean of 70.7±43.7 months from any bariatric surgery, all patients started liraglutide therapy. At this time, mean BMI was 34.2±4.8 kg/m2 (mean increased BMI: 4.7±2.8 kg/m2). After a mean of 10.5±4.4 months from the beginning of liraglutide, 9 patients achieved normal weight (BMI 24.1±0.9 kg/m2), 28 were overweight (BMI 26.9±1.6 kg/m2). Twenty patients achieved grade I (BMI 32.1±1.5 kg/m2), 5 grade II (BMI 37.3±2.0 kg/m2) obesity, none had grade III obesity (mean BMI change: -5.1±2.5 kg/m2). The treatment was well tolerated, and no serious adverse events were recorded.ConclusionThese data confirm the efficacy and safety of liraglutide in patients who experienced weight regain after bariatric surgery. Considering the long-term follow-up, patients should be followed up regularly and the pharmacological treatment should be adapted to the weight fluctuations observed during the clinical history.

scholarly journals OUTLET ROUX-Y-GASTRIC BYPASS POUCH REDUCTION USING ARGON PLASMA COAGULATION TO TREAT WEIGHT REGAIN: A Randomized Controlled Trial with SHAM Group

2021 ◽  
Author(s):  
Dr. Idiberto Jose Zotarelli Filho, MSc, Ph.D
Keyword(s):  
Weight Loss ◽  
Weight Regain ◽  
Sham Group ◽  
Controlled Trial ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Control Group ◽  
Initial Weight ◽  
Plasma Coagulation ◽  
The Mean

Aims: This study to evaluate the efficacy and complications of Argon Plasma Coagulation (APC) therapy to treat post-RYGB weight regain compared to a sham control group. Methods: 41 Patients with minimum regain of 10 kg and minimal postoperative time of 36 months was randomized into two groups. Results: In the APC group (n=21), the mean initial weight 100.4 kg, and mean regained weight of 24.94 kg. In the Sham group (n=20), the mean initial weight of 103.65 kg, and mean regained weight of 25.18 kg. Only happened anastomosis stenosis after the first APC session. The comparative results between the APC versus the Sham were percentage recovered weight loss (63.95 x-2.65), weight loss in kg (15.02 x-0.57), percentage total weight loss (14.46 x-0.62), % excess weight loss (54.32 x-2.34), and BMI reduction (5.38 x-0.21), with a p<0.0001 for all the comparisons. There was a significant reduction in the APC group of HbA1c (5.66% to 4.96%) and triglycerides (153.20mg/dL to 132.20mg/dL). Conclusion: This study proves that APC outlet pouch reduction is much superior compared to sham in promoting weight loss for patients that presented weight regain after de RYGB.

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