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ORIGINAL RESEARCH article

Front. Endocrinol.

Sec. Obesity

Volume 16 - 2025 | doi: 10.3389/fendo.2025.1662911

Endoscopic Argon Plasma Coagulation treatment for late dumping syndrome in patients with Roux-en-Y gastric bypass

Provisionally accepted
Sara  Mera CarreiroSara Mera Carreiro1,2,3Blanca  Bernaldo-MadridBlanca Bernaldo-Madrid1,2,3Clara  Clara Rodríguez-CarrilloClara Clara Rodríguez-Carrillo4José Miguel  Esteban-López-JamarJosé Miguel Esteban-López-Jamar4,5Clara  Marcuello-FoncillasClara Marcuello-Foncillas1Natalia  Pérez-FerreNatalia Pérez-Ferre1Ana  Maria Ramos-LeviAna Maria Ramos-Levi1,5Pilar  Matía-MartínPilar Matía-Martín1,5Miguel  Ángel Rubio-HerreraMiguel Ángel Rubio-Herrera1,5*
  • 1Department of Endocrinology and Nutrition, San Carlos University Clinical Hospital, Madrid, Spain
  • 2HM Hospitales, Madrid, Spain
  • 3HM Madrid Río, Department of Endocrinology and Nutrition, HM Hospitales, Madrid, Spain
  • 4Department of Gastroenterology and Hepatology, San Carlos University Clinical Hospital, Madrid, Spain
  • 5Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain

The final, formatted version of the article will be published soon.

INTRODUCTION: Dumping syndrome (DS) and postprandial hypoglycemia (PPH) post-bariatric hypoglycemia (PBH) are challenging complications encountered after Roux-en-Y gastric bypass (RYGB). Surgical revision is often the next therapeutic step when pharmacological and dietary treatments fail to control DS and PBH PPH. Endoscopic argon plasma coagulation (APC) is a less invasive alternative that reduces the diameter of the gastrojejunal anastomosis (GJA). The aim of the study is to evaluate the efficacy and safety of APC in managing postprandial hypoglycemia (PPH) DS and PBH after RYGB.METHODS: This retrospective study included patients who underwent endoscopic APC for GJA reduction between 2018 and 2022. Improvement of DS, reduction of PBH PPH, and anthropometric data were evaluated. RESULTS: Twenty-five patients aged 52.3 ± 9.2 years, with PBH PPH and poor response refractory to pharmacological treatment, were recruited. All patients had an average of two APC endoscopic procedures (range 1-4), initial GJA diameter of 26.8 ± 7.2 mm, and post-APC diameter of 16.4 ± 4.4 mm. Adverse events were mild and did not require hospitalization. Symptoms improved in 100% of patients with a decrease in Sigstad score from 8.2 ± 1.9 to 0.9 ± 2 (p < 0.0001) and resolution of PBH PPH (p < 0.0001) over the 24-month follow-up. Of these, 84% discontinued pharmacological treatment. In addition, 60% of the patients who regained weight from the nadir after RYGB had Con formato: Subíndice significant a significant percentage of total body weight loss (% TBW) (p < 0.01) after APC during the 2-year follow-up. CONCLUSION: APC is effective, safe, and reproducible in managing DS and PBH PPH in patients who undergo RYGB, refractory to dietary and pharmacological treatments. It also contributes to weight loss after weight regain.

Keywords: Endoscopic argon plasma coagulation1, Dumping syndrome2, Post-bariatric hypoglycemia 3, Postprandial hypoglycemia4, Roux-en-Y gastric bypass 4 5, Weight regain 56

Received: 09 Jul 2025; Accepted: 04 Aug 2025.

Copyright: © 2025 Mera Carreiro, Bernaldo-Madrid, Clara Rodríguez-Carrillo, Esteban-López-Jamar, Marcuello-Foncillas, Pérez-Ferre, Ramos-Levi, Matía-Martín and Rubio-Herrera. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Miguel Ángel Rubio-Herrera, Department of Endocrinology and Nutrition, San Carlos University Clinical Hospital, Madrid, Spain

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