Treatment With a GLP-1 Receptor Agonist Versus Reduction of the Gastrojejunal Anastomosis Diameter Using Endoscopic Argon Plasma Coagulation for Recurrent Weight Gain After Roux-en-Y Gastric Bypass

Introduction Approximately 30% of patients experience recurrent weight gain (RWG) within 2 years after metabolic bariatric surgery (MBS). In this setting, GLP-1 receptor agonists (GLP-1 RA) and endoscopic argon plasma coagulation (APC) can be used. The objective is to evaluate the percentage of total body weight loss (%TWL) with liraglutide 3.0 mg versus APC for patients with ≥ 10% RWG over two years. Methods Retrospective, single-center study (2018-2022) of patients with RWG after RYGB treated with liraglutide 3.0 mg or APC. Weight trajectories were additionally evaluated using a linear mixed-effects model. Results 98 patients (mean age 44.5 ± 10.2 years old) with RWG were included. 43 patients were treated with liraglutide 3.0 mg and 55 with APC. There were no statistically significant differences in pre-MBS BMI nor nadir BMI. Average RWG was 23.6 ± 12.01% (median RWG of 21.4%; IQR 16.5-26.5). Significant differences in %TWL were observed from month 12 onwards (p < 0.01), favoring the GLP-1 RA group. Consistently, a significant Time × Treatment interaction was observed in the mixed-effects model (p < 0.001), indicating different weight-loss trajectories between treatment groups. At 12 and 24 months, average %TWL was 14.84 ± 6.56% and 15.59 ± 6.07%, respectively, in the liraglutide 3.0 mg group, and 9.72 ± 8.02% and 7.03 ± 8.30% in the APC group. As a secondary outcome, approximately 43% of the patients treated with GLP-1 RA and 17% of those treated with APC maintained a BMI < 30 kg/m2 at 24 months follow-up. Conclusion Overall, patients treated with liraglutide 3.0 mg maintained a %TWL of approximately 15% between 12 and 24 months of follow-up, whereas patients treated with APC achieved a mean %TWL below 10% during the same period.