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

Sara Mera Carreiro^1,2,3Blanca Bernaldo-Madrid^1,2,3Clara Clara Rodríguez-Carrillo⁴José Miguel Esteban-López-Jamar^4,5Clara Marcuello-Foncillas¹Natalia Pérez-Ferre¹Ana Maria Ramos-Levi^1,5Pilar Matía-Martín^1,5Miguel Ángel Rubio-Herrera^1,5*

• 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

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.