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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.
Background And Aims:
Weight regain after Roux-en-Y gastric bypass is common and often linked to anatomical changes such as gastrojejunal anastomosis (GJA) dilation and pouch enlargement. Transoral outlet reduction (TORe) offers a minimally invasive alternative to surgical revision. We present a modified TORe technique incorporating submucosal dissection, argon plasma coagulation, zipper-style GJA suturing, and distal pouch tubularization.
Methods:
A 53-year-old woman with post-Roux-en-Y gastric bypass weight recurrence and GERD underwent enhanced TORe. The procedure included submucosal dissection of the GJA, argon plasma coagulation, zipper-pattern endoscopic suturing for GJA reduction, and tubularization of the distal gastric pouch.
Results:
At 6-month follow-up, the patient achieved 14% total body weight loss and resolution of GERD symptoms. No adverse events occurred.
Conclusions:
This modified zipper-TORe approach is safe and efficient and may enhance durability and clinical outcomes.
