A Real-World, Insurance-Based Algorithm Using the Two-Fold Running Suture Technique for Transoral Outlet Reduction...

Area of Science:

• Bariatric surgery outcomes
• Gastroenterology
• Endoscopic procedures

Background:

• Weight regain after Roux-en-Y gastric bypass (RYGB) is a common challenge.
• Transoral outlet reduction (TORe) using devitalization and/or endoscopic suturing (ES) is a potential management strategy.
• This study evaluates TORe efficacy and safety within an insurance-based treatment algorithm.

Purpose of the Study:

• To assess the effectiveness of TORe in patients experiencing weight regain post-RYGB.
• To evaluate the safety profile of TORe procedures.
• To determine if an insurance-based algorithm impacts TORe outcomes.

Main Methods:

• A retrospective review of a prospectively maintained database of 55 patients undergoing TORe between 2015 and 2018.
• Patients followed an insurance-based algorithm, including repeat endoscopy at 8 weeks.
• No concurrent diet, lifestyle, or pharmacotherapy interventions were provided.

Main Results:

• TORe led to an average % total body weight loss (%TBWL) of 8.2% at 3 months, peaking at 9.3% at 6 months, and decreasing to 5.5% at 12 months.
• The mean Dumping Syndrome Severity Score significantly decreased (p < 0.01).
• The adverse event rate was 14.5%; 29 patients required a second procedure, and 11 required a third.

Conclusions:

• TORe is effective for short-term weight loss and improving dumping syndrome in post-RYGB patients.
• The procedure can halt progressive weight regain.
• Long-term durability of weight loss remains a concern due to potential weight recidivism.