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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(05): E687-E696
DOI: 10.1055/a-2312-5742
Original article

Endoscopic transoral outlet reduction induces enterohormonal changes in patients with weight regain after Roux-en-Y gastric bypass

Vitor Ottoboni Brunaldi 
1   Gastrointestinal Endoscopy Unit, Gastroenterology Department, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Galileu Ferreira Farias 
2   General Surgery, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Diogo Turiani Hourneaux de Moura 
1   Gastrointestinal Endoscopy Unit, Gastroenterology Department, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Marco Aurélio Santo
3   Bariatric Surgery Unit, Gastroenterology Department, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Barham K. Abu Dayyeh
4   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Caroline Silverio Faria
5   Lim03, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Leila Antonangelo
6   Pathology Department, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Dan Linetzki Waitzberg
7   Gastroenterology Department, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
,
Eduardo Guimarães Hourneaux de Moura 
8   Gastrointestinal Endoscopy Department, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil (Ringgold ID: RIN117265)
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Abstract

Background and study aims Transoral outlet reduction (TORe) has long been employed in treating weight regain after Roux-en-Y gastric bypass. However, its impact on gut hormones and their relationship with weight loss remains unknown.

Patients and methods This was a substudy of a previous randomized clinical trial. Adults with significant weight regain and dilated gastrojejunostomy underwent TORe with argon plasma coagulation (APC) alone or APC plus endoscopic suturing (APC-suture). Serum levels of ghrelin, GLP-1, and PYY were assessed at fasting, 30, 60, 90, and 120 minutes after a standardized liquid meal. Results were compared according to allocation group, clinical success, and history of cholecystectomy.

Results Thirty-six patients (19 APC vs. 17 APC-suture) were enrolled. There were no significant baseline differences between groups. In all analyses, the typical postprandial decrease in ghrelin levels was delayed by 30 minutes, but no other changes were noted. GLP-1 levels significantly decreased at 12 months in both allocation groups. Similar findings were noted after dividing groups according to the history of cholecystectomy and clinical success. The APC cohort presented an increase in PYY levels at 90 minutes, while the APC-suture group did not. Naïve patients had significantly lower PYY levels at baseline (P = 0.01) compared with cholecystectomized individuals. This latter group experienced a significant increase in area under the curve (AUC) for PYY levels, while naïve patients did not, leading to a higher AUC at 12 months (P = 0.0001).

Conclusions TORe interferes with the dynamics of gut hormones. APC triggers a more pronounced enteroendocrine response than APC-suture, especially in cholecystectomized patients.

Keywords

Endoscopy Upper GI Tract - GI surgery

Supplementary Material



Publication History

Received: 11 May 2023

Accepted after revision: 16 April 2024

Accepted Manuscript online:
23 April 2024

Article published online:
29 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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