Transoral Outlet Reduction to Tackle Weight Regain After Roux-en-Y Gastric Bypass: a Single Center Initial Experience

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Minimally Invasive Endoscopic Procedures

Background:

• Long-term Roux-en-Y gastric bypass (RYGB) failure affects 10-15% of patients, with dilated gastro-jejunal anastomosis (GJA) being a contributing factor.
• Weight regain after RYGB necessitates effective revision strategies.
• Transoral outlet reduction (TORe) offers a potential endoscopic solution for restoring restriction.

Purpose of the Study:

• To evaluate the safety and efficacy of transoral outlet reduction (TORe) for weight regain after Roux-en-Y gastric bypass (RYGB).
• To describe the single-center experience and adverse events associated with TORe in patients with a dilated GJA.

Main Methods:

• A case series of 20 patients with weight regain after RYGB and dilated GJA.
• TORe performed using endoscopic full-thickness sutures (Apollo OverStitch®) to reduce GJA diameter and gastric reservoir volume.
• Prospective data collection on technical feasibility, safety, and efficacy with a median follow-up of 22 months.

Main Results:

• Mean BMI reduction of 3.9 kg/m² and absolute weight loss of 13 kg at 6 months post-TORe.
• Median BMI of 31.4 kg/m² at 22-month follow-up.
• Resolution of dumping symptoms in 4 patients; minor adverse events (nausea, sore throat, abdominal pain, altered bowel habits) managed conservatively; one case of mediastinitis treated successfully.

Conclusions:

• Endoscopic TORe by narrowing the GJA is an efficient and safe minimally invasive option for managing weight regain after RYGB.
• The technique demonstrates potential for successful revision in patients with dilated GJA.
• Increased clinical use of endoscopic TORe is recommended for managing failed gastric bypass.