Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-2117-8113
Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202309/lookinside/thumbnails/10-1055-a-2117-8113-1.jpg)
Abstract
Background and study aims Traditional transoral outlet reduction (TORe) is a minimally invasive endoscopic approach focused on reducing the aperture of the gastrojejunal (GJ) anastomosis, while the tubular transoral outlet reduction (tTORe) consists of tabularization of the distal pouch utilizing an O-shape gastroplasty suturing pattern. The primary aim of this study was to compare short-term weight loss between TORe and tTORe.
Patients and methods Retrospective analysis of a prospectively maintained database was conducted at a tertiary care bariatric center of excellence. The study included patients with history of Roux-en-Y gastric bypass (RYGB) who had an endoscopic revision by TORe or tTORe and had follow-up data in their electronic medical record. The primary outcome was percent total body weight loss (%TBWL).
Results A total of 128 patients were included (tTORe=85, TORe=43). At 3 and 6 months, the tTORe and TORe cohorts presented similar %TBWL (3 months: 8.5±4.9 vs. 7.3±6.0, P = 0.27 and 6 months: 8.1±7.4 vs. 6.8±5.6, P = 0.44). At 9 months, there was a trend toward greater weight loss in the tTORe cohort (9.7±8.6% vs. 5.1±6.8%, P = 0.053). At 12 months, the %TBWL was significantly higher in the tubularization group compared to the standard group (8.2±10.8 vs. 2.3±7.3%, P = 0.01). Procedure time was significantly different between both groups (60.5 vs. 53.4 minutes, P = 0.03). The adverse events rate was similar between groups (8.2% vs. 7.0% for tTORe and TORe, respectively, P = 0.61).
Conclusions The tTORe enhances efficacy and durability of the standard procedure without adding significant procedure-related risks.
Keywords
Endoscopy Upper GI Tract - Other focus (of reviewers) - GI surgery - Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Endoscopy Upper GI Tract - RFA and ablative methodsPublication History
Received: 17 October 2022
Accepted after revision: 18 April 2023
Accepted Manuscript online:
26 June 2023
Article published online:
15 September 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 English WJ, DeMaria EJ, Hutter MM. et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surgery for Obesity and Related Diseases 2020; 16: 457-463 DOI: 10.1016/j.soard.2019.12.022. (PMID: 32029370)
- 2 Ma Y, Pagoto SL, Olendzki BC. et al. Predictors of weight status following laparoscopic gastric bypass. Obes Surg 2006; 16: 1227-1231 DOI: 10.1381/096089206778392284. (PMID: 16989709)
- 3 Buchwald H, Avidor Y, Braunwald E. et al. Bariatric Surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724-1737 DOI: 10.1001/jama.292.14.1724. (PMID: 15479938)
- 4 Melton GB, Steele KE, Schweitzer MA. et al. Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities, and insurance status with outcomes. J Gastrointest Surg 2008; 12: 250-255
- 5 Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219-234
- 6 Jirapinyo P, Abu Dayyeh BK, Thompson CC. Weight regain after Roux-en-Y gastric bypass has a large negative impact on the Bariatric Quality of Life Index. BMJ open gastroenterology 2017; 4: e000153-e000153 DOI: 10.1136/bmjgast-2017-000153. (PMID: 28944069)
- 7 Elhag W, El Ansari W. Weight regain and insufficient weight loss after bariatric surgery: a call for action. Bariatric Surgery-From the Non-surgical Approach to the Post-surgery Individual Care. 2020
- 8 Cooper TC, Simmons EB, Webb K. et al. Trends in weight regain following Roux-en-y gastric bypass (RYGB) bariatric surgery. Obesity Surgery 2015; 25: 1474-1481 DOI: 10.1007/s11695-014-1560-z. (PMID: 25595383)
- 9 Freire RH, Borges MC, Alvarez-Leite JI. et al. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition 2012; 28: 53-58 DOI: 10.1016/j.nut.2011.01.011. (PMID: 21885246)
- 10 Santo MA, Riccioppo D, Pajecki D. et al. Weight regain after gastric bypass: influence of gut hormones. Obes Surg 2016; 26: 919-925 DOI: 10.1007/s11695-015-1908-z. (PMID: 26450709)
- 11 Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 2011; 9: 228-233 DOI: 10.1016/j.cgh.2010.11.004. (PMID: 21092760)
- 12 Heneghan HM, Yimcharoen P, Brethauer SA. et al. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis 2012; 8: 408-415 DOI: 10.1016/j.soard.2011.09.010. (PMID: 22055390)
- 13 Kuzminov A, Palmer AJ, Wilkinson S. et al. Re-operations after secondary bariatric surgery: a systematic review. Obesity Surgery 2016; 26: 2237-2247 DOI: 10.1007/s11695-016-2252-7. (PMID: 27272668)
- 14 Dayan D, Kuriansky J, Abu-Abeid S. Weight regain following Roux-en-Y gastric bypass: etiology and surgical treatment. Israel Med Assoc J 2019; 21: 823-828 (PMID: 31814347)
- 15 Thompson CC, Chand B, Chen YK. et al. Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology 2013; 145: 129-137.e123
- 16 Brunaldi VO, Farias GFA, de Rezende DT. et al. Argon plasma coagulation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos). Gastrointest Endosc 2020; 92: 97-107.e105
- 17 Vargas EJ, Bazerbachi F, Matar R. et al. Sa1985 Endoscopic tubular outlet reduction (TTORE) for the treatment of weight regain enhances weight loss and improves quality of life. Gastrointest Endosc 2019; 89: AB272-AB273
- 18 Abu Dayyeh B, Portela R, Mahmoud T. et al. A novel approach for weight regain after Roux-en-Y gastric bypass: Staged transoral outlet reduction (TORe) followed by surgical type 1 distalization. VideoGIE 2022; 7: 135-137 DOI: 10.1016/j.vgie.2022.01.001. (PMID: 35937196)
- 19 Brunaldi VO, Jirapinyo P, de Moura DTH. et al. Endoscopic treatment of weight regain following Roux-en-y gastric bypass: a systematic review and meta-analysis. Obesity Surgery 2017; 1-11
- 20 Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc 2016; 83: 776-779 DOI: 10.1016/j.gie.2015.08.039. (PMID: 26344204)
- 21 Jirapinyo P, Kröner PT, Thompson CC. Purse-string transoral outlet reduction (TORe) is effective at inducing weight loss and improvement in metabolic comorbidities after Roux-en-Y gastric bypass. Endoscopy 2018; 50: 371-377 DOI: 10.1055/s-0043-122380. (PMID: 29253919)
- 22 Jirapinyo P, Kumar N, AlSamman MA. et al. Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointestinal endoscopy 2020; 91: 1067-1073 DOI: 10.1016/j.gie.2019.11.044. (PMID: 31816315)
- 23 Leising D, Locke KD, Kurzius E. et al. Quantifying the association of self-enhancement bias with self-ratings of personality and life satisfaction. Assessment 2016; 23: 588-602 DOI: 10.1177/1073191115590852. (PMID: 26092044)