Endoscopic Management of Weight Regain Post-Bariatric Surgery

Weight recurrence following primary bariatric surgery occurs in a significant proportion of patients in the long-term. Causes are often multifactorial and include noncompliance with diet and lifestyle advice, psychological and demographic factors, disordered eating and anatomical or structural changes. Surgical revision to address weight recurrence is associated with significant risks. Endoscopic approaches have therefore emerged as a minimally invasive, effective alternative with significantly lower rates of adverse events, The transoral outlet reduction (TORe) procedure is used to manage weight regain after Roux-en-Y gastric bypass by reducing the diameter of the gastrojejunal anastomosis as well as address gastric pouch. In patients with weight regain following gastric sleeve surgery a revision endoscopic sleeve gastroplasty (ESG) offers an effective, safe, and even reproducible treatment. In this chapter, we discuss in detail the different endoscopic techniques that could be used in the management of weight recurrence following primary bariatric surgery.