Background

Bariatric surgery is the most effective treatment for obesity, however, a subset of patients experience significant weight regain (WR). Endoscopic revision of bariatric surgery (ERBS) is a safe and effective therapy for WR, however, few studies exist describing its effects on metabolic comorbidities.

Methods

A single-center, retrospective study of patients who underwent ERBS (transoral outlet reduction [TORe], revisional endoscopic sleeve gastroplasty of prior sleeve gastrectomy [Re-ESG]) was performed between 09/2021-09/2023. Measures of metabolic comorbidities involving liver steatosis (CAP score, steatosis stage, transaminase levels) and type II diabetes mellitus (HbA1c) pre- and post-ERBS were collected from electronic health records. Continuous variables are depicted as mean (+-SD) and paired t-tests were performed.

Results

A total of 49 patients underwent ERBS (1 ERBS of gastric plication, 37 TORe, 11 Re-ESG) after a mean 120.90 (+-74.92) months post bariatric surgery and baseline BMI of 39.84 (+-6.63) kg/m2. Patients had a mean total body weight loss of 15.49% (+-8.40%) at 12-month follow-up. Patients experienced a mean decrease of 0.2% HbA1c (95% CI0.073-0.33%, p = 0.003) after ERBS. 12 patients underwent hepatic elastography before and after (mean 10.45+- 4.41 months) ERBS. CAP scores decreased by a mean 56 dB/m (95% CI13.33-98.67, p = 0.001) and 5/12 patients improved their liver steatosis stage.

Conclusions

ERBS results in significant and durable weight loss as well as improvement in multiple metabolic comorbidities in patients with WR after bariatric surgery. Larger studies with longer follow up are needed to more fully assess the long-term effects of ERBS.