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Enhanced transoral outlet reduction using endoscopic submucosal dissection and zipper-type suture technique after
Davekaran Buttar1, Mayank Goyal1, Ashwariya Ohri1
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Summary
Weight regain after gastric bypass can be reversed with a modified transoral outlet reduction (TORe). This minimally invasive endoscopic procedure effectively reduced gastrojejunal anastomosis size and improved weight loss and GERD symptoms.
Area of Science:
- Bariatric Surgery
- Endoscopic Procedures
- Gastroenterology
Background:
- Weight regain is common after Roux-en-Y gastric bypass, often due to gastrojejunal anastomosis dilation and pouch enlargement.
- Transoral outlet reduction (TORe) presents a minimally invasive endoscopic alternative to surgical revision for weight recurrence.
- Anatomical changes in the gastrojejunal anastomosis and gastric pouch are key factors in post-bariatric surgery weight regain.
Purpose of the Study:
- To evaluate a modified transoral outlet reduction (TORe) technique for managing weight regain and GERD after Roux-en-Y gastric bypass.
- To assess the safety and efficacy of a novel endoscopic approach incorporating submucosal dissection, argon plasma coagulation, and zipper-style suturing for gastrojejunal anastomosis reduction.
- To determine the clinical outcomes, including weight loss and symptom resolution, following the enhanced TORe procedure.
Main Methods:
- A modified transoral outlet reduction (TORe) procedure was performed on a patient experiencing weight recurrence and GERD post-gastric bypass.
- The technique involved submucosal dissection of the gastrojejunal anastomosis (GJA), argon plasma coagulation, and zipper-style endoscopic suturing for GJA reduction.
- Distal gastric pouch tubularization was also incorporated into the modified TORe procedure.
Main Results:
- The patient achieved 14% total body weight loss at the 6-month follow-up.
- Gastroesophageal reflux disease (GERD) symptoms were completely resolved.
- The modified transoral outlet reduction (TORe) procedure was completed without any adverse events.
Conclusions:
- The modified zipper-TORe approach is a safe and effective endoscopic treatment for weight regain after gastric bypass.
- This enhanced transoral outlet reduction technique demonstrates potential for improved durability and clinical outcomes.
- Minimally invasive endoscopic revision of the gastrojejunal anastomosis offers a viable solution for managing bariatric surgery complications.
