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

Abstract

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.

Status of bariatric endoscopy–what does the surgeon need to know? A review

“…Among the currently available revisional therapies, endoscopic bariatric treatments include use of argon plasma coagulation (APC) and endoscopic suturing[ 24 , 25 ]. These two treatment modalities are typically used in the management of those who have undergone prior Roux-en-Y Gastric Bypass (RYGB) and aim to achieve reduction of the gastric pouch, gastrojejunal anastomosis (GJA), and in some cases, successful closure of gastrogastric fistulas (GGFs) when present.…”

“…Endoscopic suturing (transoral outlet reduction): Endoscopic suturing for patients with a history of RYGB is typically undertaken using a transoral outlet reduction (TORe) technique. The reduction in the diameter of the GJA may also be performed using an endoscopic suturing technique–often performed after APC of the GJA since the combination of methods may result in better weight loss results compared to a suturing alone[ 24 ]. The APC technique alone is more widely used due to shorter procedure times, decreased need for deep sedation or endotracheal intubation, and cost-savings.…”

The First Endoscopic Sleeve Gastroplasty and Transoral Outlet Reduction in Thailand: Case Report and Literature Review

“…The pooled rate of severe adverse events was 0.57%, with the bleeding rate of 1.14%, and the perforation rate of 0.46%. 32 Therefore, TORe appears safe, effective and durable for the treatment of weight regain or inadequate weight loss after RYGB.…”

Endoscopic therapy of weight regain after bariatric surgery

“…According to the main United States bariatric society[ 17 ], the incidence of revisional bariatric surgery rapidly increased in the last decade, from 6% in 2011 to more than 15% in 2018. The management of revisional surgery following RYGB is not standardized yet[ 18 ]. Gastric banding revision, conversion to a distal RYGB with creation of a new ileal anastomosis and biliopancreatic diversion/duodenal switch revision represent the possible management options, together with novel endoscopic procedures, such as suturing and plication, e.g.…”

“…A further systematic review and meta-analysis[ 18 ] on S-TORe following RYGB extracted 13 studies involving 850 patients. The absolute WL at 3, 6 and 12 mo was 6.1 kg, 10.2 kg and 7.1 kg, respectively.…”