Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2019; 7(15): 2038-2043
Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.2038
Acute bleeding after argon plasma coagulation for weight regain after gastric bypass: A case report
Diogo Turiani Hourneaux de Moura, Amit H Sachdev, Po-Wen Lu, Igor Braga Ribeiro, Christopher C Thompson
Diogo Turiani Hourneaux de Moura, Amit H Sachdev, Christopher C Thompson, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Department of Gastroenterology, Clinics Hospital of São Paulo University, São Paulo 05403-00, Brazil
Po-Wen Lu, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33305, Taiwan
Author contributions: de Moura DTH wrote the paper; Sachdev AH performed the procedures; Lu P and Ribeiro IB collected patient’s data; Thompson CC designed the case report; final version was approved by all authors.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Diogo Turiani Hourneaux de Moura, MD, MSc, PhD, Academic Fellow, Postdoctoral Fellow, Research Fellow, Surgeon, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, United States.
Telephone: +1-857-2509586‬
Received: April 2, 2019
Peer-review started: April 4, 2019
First decision: June 21, 2019
Revised: June 21, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 6, 2019

Roux-en-Y gastric bypass (RYGB) is the most commonly performed surgical procedure used to treat obesity worldwide. Despite satisfactory results in terms of weight loss, over time many patients experience weight regain. There are many factors that contribute to weight regain after RYGB, including the diameter of the gastric-jejunal anastomosis (GJA). One of the most commonly performed endoscopic procedures for weight regain after RYGB is argon plasma coagulation (APC). We report a case of hematemesis after outlet revision with APC. We highlight several treatment modalities that can be used to treat this complication.


A 45-year-old female with a history of weight regain after RYGB was referred for possible endoscopic treatment for weight regain. On endoscopic evaluation, the diameter of the GJA was 22 mm. Due to the dilated GJA, treatment with APC was performed. Several months later she reported a return of poor satiety and an increased appetite. A repeat endoscopy was then performed. The GJA was approximately 15 mm and was incompetent. APC was performed. One day post procedure she had four episodes of hematemesis. An endoscopy was performed and a large ulcer with a visible arterial vessel was visualized at the GJA. Coagulation was attempted using a Coagrasper and after initial contact with the vessel, the vessel started oozing. Due to fibrosis and the depth of ulceration in the area, clips and repeat APC could not be used. Therefore, an attempt to inject epinephrine injection was made. However, persistent oozing was noted. As a result, hemostatic powder was applied to the region of the bleeding vessel. Subsequently, no more bleeding was observed. On follow-up, the patient remained hemodynamically stable and a second look endoscopy was not performed. The patient was discharged three days later.


APC revision of the GJA is known to be a relatively safe and effective strategy to manage weight regain post RYGB. Anastomotic site bleeding is an infrequent and potentially life-threatening complication associated with this therapy. Endoscopic management is the first line therapy used to achieve hemostasis in these cases.

Keywords: Anastomosis, Roux-en-Y, Argon plasma coagulation, Bariatric, Gastric bypass, Gastrointestinal hemorrhage, Case report

Core tip: We report a case of a patient with weight regain after Roux-en-Y gastric bypass presenting with gastrointestinal bleeding after recent outlet revision with argon plasma coagulation. We highlight several treatment modalities, including mechanical, thermal, and topical endoscopic therapies that can be used to treat this complication.