Eficácia do plasma de argônio no tratamento de pacientes com recidiva de peso no pós-operatório do bypass gástrico com perfil demográfico, endoscópico e clínico: um ensaio clínico randomizado

Abstract

Approximately, 10 to 20% of patients undergoing bariatric surgery have weight regain after the second year of the procedure, caused by several factors. Some interventions have been proposed to assist weight loss in these patients. In this case, the endoscopic procedure with the use of argon stands out, which acts to reduce the gastrojejunal anastomosis by promoting a progressive reduction in its diameter, and consequent delay in gastric emptying and early satiety. Objectives: To evaluate the effectiveness of application of argon plasma coagulation (APC) in patients with weight regain in the postoperative period of gastric bypass in the short, medium and long terms, considering demographic, clinical, operative and endoscopic aspects, with follow-up over a period of time one year. Methods: Randomized, blinded, controlled clinical trial with 66 patients who underwent gastric bypass after weight regain, in periods of 30, 60, 90, 120, 150, 180 days and one year; divided into two groups: Study Group (SG): 38 patients undergoing APC; and Control Group (CG): 28 patients who underwent endoscopy without APC. All participants underwent upper digestive endoscopy and were encouraged to perform multidisciplinary follow-up. One year after the application, SG patients were submitted to a new endoscopy, with biopsy, to assess the gastrojejunal anastomosis. Statistical analysis included the Kolmogorov-Smirnov, t test, ANOVA, Kruskal-Wallis tests, Pearson/Spearman correlation and multiple linear regression. Values of p <0.05 were considered significant. Results: After APC, it was observed that 97.3% of SG patients, with an initial weight of 98.5 ± 21.2 kg, Body Mass Index (BMI) 37.5 ± 6.3 kg / m² and weight regain of 33.7 ± 17.4%, showed significant weight loss after 30 days, which remained until 180 days after the procedure (p<0.05). In this case, there was a reduction in recurrent weight (RRW) by 69.4 ± 47.8%, % Excess Weight Loss (%EWL) of 7.4 ± 3.8 kg, Excess Weight Loss (EWL) of 30.3 ± 25.5% and total weight loss (TWL) of 7.5 ± 3.6%. Regarding the control group, with an initial weight of 95.6 ± 15.7 kg, BMI 36.3 ± 6.25 kg / m² and a weight regain of 31.0 ± 19.3%, it was observed that 53.5% weight loss compared to SG (p <0.05), with a reduction of 13.8 ± 38.9% of the recurrent weight, representing TWL of 1.7 ± 3.8 kg, %EWL of 6.4 ± 18.5% and %TWL of 1.8 ± 4.2% over a period of up to 180 days. One year after the beginning of the follow-up, the final analysis of the weight did not show any difference between the groups (p=0.964), however, the values referring to the reduction of %EWL and %TWL were higher in the SG in relation to the CG (p=0.038; p=0.045, respectively). The biopsy performed after one year of APC in the SG, did not reveal neoplastic histological changes. Conclusions: APC is effective in the treatment of weight regain after bariatric surgery in the short and medium term. In the long term, it is shown to be significant in the reduction of excess weight and in the percentage of total weight in relation to the control group. In addition, it is a safe procedure, with low complication rates and not a precursor of neoplastic cells.