Dose response for argon plasma coagulation in the treatment of weight regain after Roux-en-Y gastric bypass

Background and Aims: Argon plasma coagulation (APC) of gastrojejunal anastomosis (GJA) is effective in treating weight regain after Roux-en-Y gastric bypass (RYGB). This study aims to compare the efficacy of different APC settings for treating weight regain. Methods: This was a single-center retrospective study of patients who had undergone RYGB and then underwent APC from 2014 to 2018 for weight regain. Patients receiving only low-dose APC (45-55 W) or high-dose APC (70-80 W) were compared. The primary outcome was the difference in percentage total weight loss (% TWL) between the groups at 6 and 12 months after the last treatment. Secondary outcomes were technical success, adverse events (AEs), and predictors of weight loss at 12 months. Results: Two hundred seventeen patients met the inclusion criteria and underwent 411 APC sessions. Of these, 116 (53.5%) patients underwent 267 low-dose APC sessions (2.4 +/- 1.5 sessions/patient) and 101 (46.5%) patients underwent 144 high-dose APC sessions (1.4 +/- 0.7 sessions/patient). Follow-up rates were 82.9% and 75.3% at 6 and 12 months. At 6 months, the low- and high-dose groups experienced 7.3% +/- 6.6% and 8.1% +/- 7.4% TWL, respectively (P = .41). At 12 months, the low- and high-dose groups experienced 5.1% + 8.5% and 9.7% +/- 10.0% TWL, respectively (P = .008). Technical success was 100%. The overall AE rate was 8.0%; the most common AE was GJA stenosis (4.6%). The GJA stenosis rate was similar for the low- and high-dose groups (3.0% vs 7.6%, P = .06). High-dose APC remained a significant predictor of greater weight loss at 1 year after controlling for confounders. Conclusion: APC is effective at treating weight regain after RYGB, and higher-watt APC was associated with greater weight loss.