A Real-World, Insurance-Based Algorithm Using the Two-Fold Running Suture Technique for Transoral Outlet Reduction for Weight Regain and Dumping Syndrome After Roux-En-Y Gastric Bypass

Fayad, Lea; Schweitzer, Michael; Raad, Micheal; Şimşek, Halis; Oleas, Roberto; Dunlap, Margo; Shah, Tazkia; Doshi, Jay; Asmar, Margueritta El; Oberbach, Andreas; Singh, Vikesh K.; Steele, Kimberly; Magnussen, Thomas; Kalloo, Anthony N.; Khashab, Mouen A.; Kumbhari, Vivek

doi:10.1007/s11695-019-03828-1

Cited by 15 publications

(19 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Technical details of the procedure, such as mucosal ablation before suturing, suture pattern, and reinforcement suturing in the pouch, have also been further refined to optimize weight loss outcomes. [10][11][12][13] With the most common current technique, which includes mucosal ablation with argon plasma coagulation (APC) around the GJA followed by suturing of the GJA with or without reinforcement suturing in the distal pouch, patients experience approximately 8.4% TWL at 1 year with significant improvement in obesity-related comorbidities. 14 A medium-term study demonstrated that patients who underwent TORe were able to maintain significant weight loss up to at least 3 years.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass

Jirapinyo

Kumar

Alsamman

et al. 2020

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

Background and Aims: Transoral outlet reduction (TORe) is a common endoscopic treatment for patients with weight regain after Roux-en-Y gastric bypass (RYGB) with a dilated gastrojejunal anastomosis (GJA). This study aims to assess long-term efficacy of TORe. Methods: This was a retrospective review of prospectively collected data on RYGB patients who underwent TORe for weight regain or inadequate weight loss. The primary outcome was efficacy of TORe at 1, 3, and 5 years. Secondary outcomes were procedure details, safety profile, and predictors of long-term weight loss after TORe. Results: Three hundred thirty-one RYGB patients underwent 342 TORe procedures and met inclusion criteria. Of these, 331, 258, and 123 patients were eligible for 1-, 3-and 5-year follow-ups, respectively. Mean body mass index was 40 AE 9 kg/m 2. Pre-TORe GJA size was 23.4 AE 6.0 mm, which decreased to 8.4 AE 1.6 mm after TORe. Patients experienced 8.5% AE 8.5%, 6.9% AE 10.1%, and 8.8% AE 12.5% total weight loss (TWL) at 1, 3, and 5 years with follow-up rates of 83.3%, 81.8%, and 82.9%, respectively. Of 342 TORe procedures, 76%, 17.5%, 4.4%, and 2.1% were performed using single purse-string, interrupted, double purse-string, and running suture patterns, respectively, with an average of 9 AE 4 stitches per GJA. Pouch reinforcement suturing was performed in 57.3%, with an average of 3 AE 2 stitches per pouch. There were no severe adverse events. Some patients (39.3%) had additional weight loss therapy (pharmacotherapy or procedure), with 3.6% getting repeat TORe.

show abstract

mentioning

confidence: 99%

“…B, Purse-string suture pattern. One suture is used to place multiple stitches (usually[8][9][10][11][12][13][14] around the gastrojejunal anastomosis in a continuous circumferential fashion before cinching over a hydrostatic balloon (usually 7-12 mm). C, Running suture pattern.…”

mentioning

confidence: 99%

Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass

Jirapinyo

Kumar

Alsamman

et al. 2020

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

show abstract

“…Areas of interest involve the different types of suture styles with the Apollo device and how they affect patients in the long run. Currently, pursestring sutures may provide the best results for sustained weight loss [23,27,36,37]. ▶…”

Section: Discussionmentioning

confidence: 99%

“…Four studies [12, 23-25] ▶ Table 1 Quality assessment of the study with Newcastle Ottawa Scale and Jadad scale. considered post procedure GJA size < 10 mm and four studies [26][27][28][29] considered post-procedure GJA size < 12 mm to be technically successful. Absolute weight loss was calculated using the formula TORe weight-follow up weight and TWL was defined as (TORe weight-follow up weight)/TORe weight x 100 %.…”

Section: Definition Of Outcomesmentioning

confidence: 99%

Efficacy of transoral outlet reduction in Roux-en-Y gastric bypass patients to promote weight loss: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Background and study aims Transoral outlet reduction (TORe) is an endoscopic procedure used in patients with weight gain post Roux-en-Y gastric bypass (RYGB). We performed a systematic review and meta-analysis to evaluate the efficacy and safety of TORe with a full-thickness suturing device for treating patients with weight regain after RYGB. Patients and methods We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google-Scholar, MEDLINE, SCOPUS, and Web of Science databases (earliest inception to March 2020). The primary outcomes assessed were technical success, absolute weight loss (AWL) and percent of total weight loss (% TWL) at 3, 6, and 12 months after the procedure. The secondary outcomes assessed were pooled rate of adverse events (AEs), adverse event subtypes and association of size of gastrojejunal anastomosis (GJA) and percent TWL. Results Thirteen studies on 850 patients were included. The pooled rate of technical success was 99.89 %. The absolute weight loss (kg) at 3, 6, and 12 months was 6.14, 10.15, and 7.14, respectively. The percent TWL at 3, 6, and 12 months was 6.69, 11.34, and 8.55, respectively. The pooled rate of AE was 11.4 % with abdominal pain being the most common adverse event. The correlation coefficient (r) was –0.11 between post TORe GJA size and weight loss at 12 months. Conclusion TORe is an endoscopic procedure that is safe and technically feasible for post RYGB with weight gain.

show abstract

“…A prime example of this application is the transoral outlet reduction (TORe) using APC in addition to endoscopic suturing. 7 To induce fibrosis of the stomach and increase the longevity of the sleeve-like conformation we applied APC to the accordioned wall of the stomach in a patient undergoing ESG.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic sleeve gastroplasty with argon plasma coagulation: A novel technique

Itani

Farha

Sartoretto³

et al. 2020

J of Digest Diseases

Self Cite

View full text Add to dashboard Cite

The endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure in which the anterior and posterior aspects of the greater curvature are stitched endoscopically, producing a sleeve-like anatomy mimicking that in a sleeve gastrectomy. However, suture dehiscence and enlargement of the stomach within months of the procedure have been observed. Argon plasma coagulation (APC) is widely used in gastrointestinal endoscopy and is able to induce scarring and fibrosis. We coupled ESG with APC to evaluate its potential to improve durability. Methods: A 46-year-old woman with obesity presented for ESG. Her pre-procedure weight was 117 kg with a body mass index (BMI) of 41.4 kg/m 2. After each plication was complete, APC (60 W, argon flow rate 1.2 L/min) was used to ablate the mucosal surface of the exposed plicated mucosa. APC was applied until the mucosal color was dark brown, indicating adequate and successful mucosal and submucosal ablation. Results: The procedure was successful, and the patient recovered without peri-or postoperative complications. The procedure time was 47 minutes. A total of seven sutures were used. At 6-month follow-up the patient had lost 17 kg (37.5 lbs), equivalent to 14.5% total weight loss and had a BMI of 35.4 kg/m 2. Endoscopic follow-up at 6 months revealed enhanced fibrosis along the plications, resulting in a superior, sleeve-like lumen. Conclusions: The combination of ESG with APC may act synergistically to reduce weight without adding significant procedure time. Further investigation is needed to determine whether it should be widely recommended.

show abstract

A Real-World, Insurance-Based Algorithm Using the Two-Fold Running Suture Technique for Transoral Outlet Reduction for Weight Regain and Dumping Syndrome After Roux-En-Y Gastric Bypass

Cited by 15 publications

References 26 publications

Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass

Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass

Efficacy of transoral outlet reduction in Roux-en-Y gastric bypass patients to promote weight loss: a systematic review and meta-analysis

Endoscopic sleeve gastroplasty with argon plasma coagulation: A novel technique

Contact Info

Product

Resources

About