Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

ARTICLE HIGHLIGHTS

Research background

Given the chronic, progressive nature of obesity, recurrence of 20%-30% of weight lost is common in the decade following Roux-en-Y gastric bypass (RYGB).

Research motivation

Surgical interventions for weight recurrence after RYGB carry heightened risks. Patients may be more amenable to the minimally-invasive endoscopic revision known as transoral outlet reduction (TORe). Though United States Food and Drug Administration-authorized, very little data exists on the implementation of TORe in the community setting.

Research objectives

To clarify the safety, efficacy, and technically feasibility of purse-string TORe in the community setting.

Research methods

This was a retrospective evaluation of a prospectively-maintained cohort of adult patients undergoing purse-string TORe in an ambulatory surgical center at a practice with expertise in endoscopic bariatric therapies. The primary outcome was total body weight loss at 12 mo. Secondary outcomes included excess weight loss within the first year, safety, predictors of total body weight loss (TBWL) response at 12 mo, and rates of post-TORe gastrojejunal anastomosis (GJA) stenosis.

Research results

In this cohort of 284 adults who underwent TORe in the community setting for weight recurrence following RYGB, 12-mo total body weight loss was 17.4%, and 81.2% achieved ≥ 10% TBWL. The number of follow up visits was the strongest predictor of 12-mo TBWL. Serious adverse events were rare and included one episode of post-operative nausea and vomiting requiring hospitalization (0.4%). Post-TORe stenosis occurred in 3.9% of subjects after an average of 57 d from TORe and was successfully managed with 1-2 endoscopic dilations. In this single largest cohort of patients undergoing TORe with a consistent purse-string technique, the procedure was shown to be safe and effective in the community setting.

Research conclusions

When performed by experienced endoscopists and supported by longitudinal nutritional aftercare, purse-string TORe is an effective, safe, and feasible tool in the community setting to address weight recurrence after RYGB.

Research perspectives

Further study of TORe should evaluate the impact of the procedure on weight related comorbidities, which are shown to reemerge with weight recurrence after RYGB. Investigation into application of TORe to other metabolic and bariatric surgeries with a GJA (such as the one-anastomosis gastric bypass) and other clinical entities in RYGB (such as dumping syndrome and bile acid reflux) will also be valuable to the field.