A novel approach for weight regain after Roux-en-Y gastric bypass: Staged transoral outlet reduction (TORe) followed by surgical type 1 distalization

Dayyeh, Barham Abu; Portela, Ray; Mahmoud, Tala; Ghazi, Rabih; Ghanem, Omar M.

doi:10.1016/j.vgie.2022.01.001

Cited by 8 publications

(9 citation statements)

References 7 publications

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“…There are several other TORe techniques described in the literature [ 35 , 37 , 38 , 39 , 40 ]. Initially, some studies demonstrated efficacy using APC alone in the GJA, which was relatively simple to perform, and even feasible with patients under conscious sedation [ 41 , 42 , 43 , 44 ].…”

Section: Tore Techniquementioning

confidence: 99%

“…A new approach combining the restriction component of TORe followed by type 1 surgical distalization of the Roux limb may be another alternative for managing weight regain in high-BMI patients after RYGB; however, this could result in greater malabsorption, leading to greater deficiency syndrome [ 40 ].…”

Section: Tore Techniquementioning

confidence: 99%

“…On the other hand, the TORe procedure has demonstrated a high degree of safety, with only minor intraprocedural adverse effects (AE) such as superficial lacerations of the esophageal mucosa due to the use of the overtube [ 12 , 17 , 18 , 19 , 29 , 30 , 31 , 32 , 33 , 45 , 46 , 47 ]. Additional postprocedural serious AEs include bleeding from marginal ulceration and GJA stenosis [ 20 , 21 , 22 , 25 , 30 , 31 , 32 , 33 , 34 , 40 , 41 , 42 ]. In general, AEs can be successfully managed endoscopically without the need for surgery.…”

Section: Tore Techniquementioning

confidence: 99%

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Transoral Outlet Reduction (TORe) for the Treatment of Weight Regain and Dumping Syndrome after Roux-en-Y Gastric Bypass

Hakiza

Sartoretto²,

Burgmann

et al. 2023

Medicina

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Obesity is a chronic relapsing disease of global pandemic proportions. In this context, an increasing number of patients are undergoing bariatric surgery, which is considered the most effective weight loss treatment for long-term improvement in obesity-related comorbidities. One of the most popular bariatric surgeries is the Roux-en-Y gastric bypass (RYGB). Despite its proven short- and long-term efficacy, progressive weight regain and dumping symptoms remain a challenge. Revisional bariatric surgery is indicated when dietary and lifestyle modification, pharmaceutical agents and/or psychological therapy fail to arrest weight regain or control dumping. However, these re-interventions present greater technical difficulty and are accompanied by an increased risk of peri- and postoperative complications with substantial morbidity and mortality. The endoscopic approach to gastrojejunal anastomotic revision, transoral outlet reduction (TORe), is used as a minimally invasive treatment that aims to reduce the diameter of the gastrojejunal anastomosis, delaying gastric emptying and increasing satiety. With substantial published data supporting its use, TORe is an effective and safe bariatric endoscopic technique for addressing weight regain and dumping syndrome after RYGB.

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Section: Tore Techniquementioning

confidence: 99%

Section: Tore Techniquementioning

confidence: 99%

Section: Tore Techniquementioning

confidence: 99%

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Transoral Outlet Reduction (TORe) for the Treatment of Weight Regain and Dumping Syndrome after Roux-en-Y Gastric Bypass

Hakiza

Sartoretto²,

Burgmann

et al. 2023

Medicina

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“…While surgical revision is invasive and carries a significant risk of adverse events (AEs) [13,14], the transoral approach to the pouch and GJ is easy and safe. Consequently, several centers have successfully employed endoscopic suturing to reduce the stoma size and/or the pouch size to treat WR [15][16][17][18]. Currently, the most common technique involves mucosal ablation with argon plasma coagulation (APC) around the GJA (supplemental figure 1) before applying running stitches [19].…”

Section: Supplementalmentioning

confidence: 99%

Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence

et al. 2023

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Background 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 is to compare the short-term weight loss between TORe and tTORe. 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 % 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 towards 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). Conclusion The tTORe enhances efficacy and durability of the standard procedure without adding significant procedure-related risks.

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“…TORe has been studied with adjunctive pharmacotherapies, and with combined laparoscopic lengthening of the Roux-limb ( 31 ). These adjunct therapies enhanced efficacy and durability in the short and mid-term ( 12 ).…”

Section: Roux-en-y Gastric Bypassmentioning

confidence: 99%

Endoscopic Management of Weight Recurrence Following Bariatric Surgery

et al. 2022

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Metabolic and bariatric surgery is the most effective therapy for weight loss and improving obesity-related comorbidities, comprising the Roux-en-Y gastric bypass (RYGB), gastric banding, sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch. While the effectiveness of weight loss surgery is well-rooted in existing literature, weight recurrence (WR) following bariatric surgery is a concern. Endoscopic bariatric therapy presents an anatomy-preserving and minimally invasive option for managing WR in select cases. In this review article, we will highlight the endoscopic management techniques for WR for the most commonly performed bariatric surgeries in the United States –RYGB and SG. For each endoscopic technique, we will review weight loss outcomes in the short and mid-terms and discuss safety and known adverse events. While there are multiple endoscopic options to help address anatomical issues, patients should be managed in a multidisciplinary approach to address anatomical, nutritional, psychological, and social factors contributing to WR.

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A novel approach for weight regain after Roux-en-Y gastric bypass: Staged transoral outlet reduction (TORe) followed by surgical type 1 distalization

Cited by 8 publications

References 7 publications

Transoral Outlet Reduction (TORe) for the Treatment of Weight Regain and Dumping Syndrome after Roux-en-Y Gastric Bypass

Transoral Outlet Reduction (TORe) for the Treatment of Weight Regain and Dumping Syndrome after Roux-en-Y Gastric Bypass

Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence

Endoscopic Management of Weight Recurrence Following Bariatric Surgery

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