From millimeter to function and from procedure to program: the role of argon plasma coagulation in weight recovery...

Weight regain following Roux-en-Y gastric bypass (RYGB) is a common and clinically significant manifestation of obesity as a chronic, progressive, and recurrent disease. Anatomical factors, particularly dilation of the gastrojejunal anastomosis, have driven the development of endoscopic revision techniques such as argon plasma coagulation (APC) and transoral reduction of the gastric outlet (TORe). Rodríguez Carrillo et al. present the first Spanish experience with APC for weight regain following RYGB, demonstrating clinically significant weight loss and a favorable safety profile. Beyond confirming the feasibility of the technique, their results raise broader questions. Early weight response may help identify patients who require intensified therapy, although it should not be interpreted as a definitive threshold for treatment failure. Likewise, the absence of a clear association between reduction in anastomotic diameter and weight loss reinforces the need to evaluate the anastomosis from a functional perspective rather than an exclusively anatomical one. APC protocols remain insufficiently standardized in terms of energy levels, number of sessions, target diameter, and criteria for discontinuation. The emergence of highly effective anti-obesity drugs has also changed the therapeutic landscape. The current challenge is not to choose between endoscopy and pharmacotherapy, but to determine their sequence and combination. Optimal management requires integrating anatomy, gastrointestinal physiology, pharmacotherapy, and multidisciplinary follow-up, along with prospective studies and accredited registries that enable the establishment of algorithms, durability, cost-effectiveness, and predictors of response.