Transoral Outlet Reduction Research Articles

Tu1473 Transoral Outlet Reduction (TORE) Versus Surgical Revision for Weight Regain After Gastric Bypass: A Matched Cohort Study

Tu1473 Transoral Outlet Reduction (TORE) Versus Surgical Revision for Weight Regain After Gastric Bypass: A Matched Cohort Study

Mo2038 Transoral Outlet Reduction (TORe) for Weight Regain After Gastric Bypass: Long-Term Follow-Up and Number Needed to Treat

Mo2038 Transoral Outlet Reduction (TORe) for Weight Regain After Gastric Bypass: Long-Term Follow-Up and Number Needed to Treat

Comparison of a superficial suturing device with a full-thickness suturing device for transoral outlet reduction (with videos)

Larger gastrojejunal (GJ) anastomosis aperture is one independent predictor for weight regain after Roux-en-Y gastric bypass. Transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain by using a superficial-thickness (ST) suturing device. Full-thickness (FT) suturing devices are now available, potentially providing more effective results. To compare effectiveness of superficial-thickness with full-thickness TORe. Matched cohort study: patients were matched sequentially by GJ anastomosis aperture, body mass index, and age. Tertiary-care center. A total of 59 consecutive patients undergoing full-thickness TORe were matched with 59 patients undergoing superficial-thickness TORe. All had GJ anastomosis apertures >20 mm. Transoral outlet reduction. Weight loss and rate of adverse events. Post-TORe GJ anastomosis apertures were similar between groups (ST 6.9 ± 0.2 mm vs FT 7.1 ± 0.3 mm). Weight loss was greater at 6 months in the FT group (10.6 ± 1.8 kg in FT vs 4.4 ± 0.8 kg in ST; P < .01) and at 1 year (8.6 ± 2.5 kg in FT vs 2.9 ± 1.0 kg in ST; P < .01). Excess weight loss was greater in the FT group at 6 months (20.4 ± 3.3% in FT vs 8.1 ± 2.5% in ST; P < .01) and at 1 year (18.9 ± 5.4% in FT vs 9.1 ± 2.3% in ST; P = .03). This was a single-center, retrospective, cohort study. There is level 1b evidence for effectiveness of TORe by using a superficial mucosal suturing device. This matched cohort study compared TORe by using the same ST suturing device with TORe by using a newer, FT suturing device and the same operative methods. FT TORe resulted in significantly more weight loss than ST TORe at 6 months and at 1 year. Full-thickness TORe is a significant improvement over ST TORe for endoscopic therapy of weight regain in patients with dilated GJ anastomosis.

Commentaire de travail de Jirapinyo P et al., pp. 532

See also: Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypassEndoscopy 2013; 45(07): 532-536DOI: 10.1055/s-0032-1326638

Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass

A dilated gastrojejunal anastomosis (GJA) is thought to be associated with weight regain in patients with Roux-en-Y gastric bypass (RYGB). Due to a high rate of perioperative morbidity, surgical revision is not generally performed. The aim of this study was to assess the technical feasibility, safety, and early outcomes of a procedure using a commercially available endoscopic suturing device to reduce the diameter of the GJA. This was a retrospective analysis of 25 consecutive patients who underwent transoral outlet reduction (TORe) for dilated GJA and weight regain. An endoscopic suturing device was used to place sutures at the margin of the GJA in order to reduce its aperture. On chart review, clinical data were available at 3, 6, and 12 months. Patients had regained a mean of 24 kg from their weight loss nadir and had a mean body mass index of 43 kg/m2 at the time of endoscopic revision. Average anastomosis diameter was 26.4 mm. Technical success was achieved in all patients (100 %) with a mean reduction in anastomosis diameter to 6 mm (range 3 - 10 mm), representing a 77.3 % reduction. The mean weight loss in successful cases was 11.5 kg, 11.7 kg, and 10.8 kg at 3, 6, and 12 months, respectively. There were no major complications. This case series demonstrated the technical feasibility, safety, and efficacy of performing gastrojejunostomy reduction using a commercially available endoscopic suturing device. This technique may represent an effective and minimally invasive option for the management of weight regain in patients with RYGB.

Sa1430 Transoral Outlet Reduction for Treatment of Weight Regain After RYGB: a Number Needed to Treat Analysis

Sa1430 Transoral Outlet Reduction for Treatment of Weight Regain After RYGB: a Number Needed to Treat Analysis

Sa1433 Comparison of a Suction-Based Superficial Suturing Device With a Full-Thickness Suturing Device for Transoral Outlet Reduction: a Matched Cohort Study

Sa1433 Comparison of a Suction-Based Superficial Suturing Device With a Full-Thickness Suturing Device for Transoral Outlet Reduction: a Matched Cohort Study

306 Randomized Double-Blind Sham-Controlled Trial of Transoral Outlet Reduction for Weight Regain After Roux-en-Y Gastric Bypass: Single-Center Results

306 Randomized Double-Blind Sham-Controlled Trial of Transoral Outlet Reduction for Weight Regain After Roux-en-Y Gastric Bypass: Single-Center Results

Mo1997 Comparison of Full-Thickness Sutured Transoral Outlet Reduction and Endoscopic Sclerotherapy for Weight Regain After Roux-en-Y Gastric Bypass

Mo1997 Comparison of Full-Thickness Sutured Transoral Outlet Reduction and Endoscopic Sclerotherapy for Weight Regain After Roux-en-Y Gastric Bypass

Endoscopic Suturing for Transoral Outlet Reduction Increases Weight Loss After Roux-en-Y Gastric Bypass Surgery

Weight regain or insufficient loss after Roux-en-Y gastric bypass (RYGB) is common. This is partially attributable to dilatation of the gastrojejunostomy (GJ), which diminishes the restrictive capacity of RYGB. Endoluminal interventions for GJ reduction are being explored as alternatives to revision surgery. We performed a randomized, blinded, sham-controlled trial to evaluate weight loss after sutured transoral outlet reduction (TORe). Patients with weight regain or inadequate loss after RYGB and GJ diameter greater than 2 cm were assigned randomly to groups that underwent TORe (n= 50) or a sham procedure (controls, n= 27). Intraoperative performance, safety, weight loss, and clinical outcomes were assessed. Subjects who received TORe had a significantly greater mean percentage weight loss from baseline (3.5%; 95% confidence interval, 1.8%-5.3%) than controls (0.4%; 95% confidence interval, 2.3% weight gain to 3.0% weight loss) (P= .021), using a last observation carried forward intent-to-treat analysis. As-treated analysis also showed greater mean percentage weight loss in the TORe group than controls (3.9% and 0.2%, respectively; P= .014). Weight loss or stabilization was achieved in 96% subjects receiving TORe and 78% of controls (P= .019). The TORe group had reduced systolic and diastolic blood pressure (P < .001) and a trend toward improved metabolic indices. In addition, 85% of the TORe group reported compliance with the healthy lifestyle eating program, compared with 53.8% of controls; 83% of TORe subjects said they would undergo the procedure again, and 78% said they would recommend the procedure to a friend. The groups had similar frequencies of adverse events. A multicenter randomized trial provides Level I evidence that TORe reduces weight regain after RYGB. These results were achieved using a superficial suction-based device; greater levels of weight loss could be achieved with newer, full-thickness suturing devices. TORe is one approach to avoid weight regain; a longitudinal multidisciplinary approach with dietary counseling and behavioral changes are required for long-term results. ClinicalTrials.gov identifier: NCT00394212.