Evaluation of endoscopic gastrojejunostomy revision after Roux-en-Y gastric bypass for treatment of dumping syndrome

Petchers, Adam; Walker, Amanda; Bertram, Ceyda; Feustel, Paul; Singh, Tejender Paul; Zaman, Jessica A.

doi:10.1016/j.gie.2022.04.1306

Cited by 9 publications

(16 citation statements)

References 26 publications

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“…TORe’s good safety profile was confirmed also with regards to dumping syndrome treatment, as no severe adverse events have been reported, except for Petchers et al who described acute gastrointestinal bleeding from anastomotic ulceration within 30-days after the procedure [ 32 , 44 , 45 , 46 , 47 , 48 ].…”

Section: Tore For Dumping Syndromementioning

confidence: 89%

“…Endoscopic transoral outlet reduction (TORe) has recently been proposed as a minimally invasive treatment for patients with dumping syndrome refractory to medical therapy after RYGB [ 32 , 44 , 45 , 46 , 47 , 48 ]. The rationale for this procedure is to reduce the diameter of the anastomosis, thus delaying gastric emptying [ 32 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…A statistically significant reduction of Sigstad’s dumping score has been reported in four studies at different times during follow-ups within 1 year after TORe [ 32 , 44 , 45 , 46 ]. In addition, two studies showed an 80% and 84% resolution of dumping syndrome at 2- and 3.5-year follow-ups, respectively [ 47 , 48 ]. However, the enlargement of the anastomosis may not be the only etiologic factor involved in dumpling syndrome, and this is probably the reason why a minority of patients do not respond to anastomosis reduction [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…TORe demonstrated having a satisfactory safety profile, with a < 1% rate of severe adverse events and no procedure-related deaths reported [ 29 , 30 , 31 , 32 , 33 , 35 , 36 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in a recent large study by Petchers et al including 98 patients, the reported resolution rate of dumping syndrome was 88% at one month and 84% at the long-term follow-up after TORe (an average of 3.5 years) [ 48 ]. In this series, only 7% of the included patients required a second intervention 2–3 years after the first one because of symptoms recurrence and endoscopic evidence of a recurrent enlargement of the anastomosis.…”

Section: Tore For Dumping Syndromementioning

confidence: 99%

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Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction

Matteo

Gallo

Pontecorvi

et al. 2022

JPM

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Obesity is a chronic, relapsing disease representing a global epidemic. To date, bariatric surgery is the most effective treatment for morbid obesity in the long-term. Roux-en-Y gastric bypass (RYGB) is one of the most performed bariatric interventions, with excellent long-term outcomes. However, about one-third of patients may experience weight regain over time, as well as dumping syndrome. Both these conditions are challenging to manage and require a multidisciplinary and personalized approach. The dilation of the gastro-jejunal anastomosis is a recognized etiological factor for both weight regain and dumping syndrome. Dietary modifications, behavioral interventions, and medications represent the first therapeutic step. Revisional surgery is the traditional approach when non-invasive treatments fail. However, re-interventions may be technically difficult and are associated with increased morbidity and mortality. Transoral outlet reduction (TORe) is an endoscopic procedure aimed at reducing the size of the anastomosis and is proposed as a minimally invasive treatment of weight regain and/or dumping syndrome refractory to conservative therapies. This review is aimed at providing a narrative overview of the role of TORe as part of the multidisciplinary therapeutic toolkit nowadays available to approach weight regain and dumping syndrome after RYGB.

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Section: Tore For Dumping Syndromementioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Tore For Dumping Syndromementioning

confidence: 99%

See 3 more Smart Citations

Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction

Matteo

Gallo

Pontecorvi

et al. 2022

JPM

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Long-term results after transoral outlet reduction (TORe) of the gastrojejunal anastomosis for secondary weight regain and dumping syndrome after Roux-en-Y gastric bypass

Lovis,

Fischli,

Mongelli

et al. 2024

Surg Endosc

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Background Bariatric surgery has been proven to be the most effective therapy for obesity and Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedure. However, weight regain and dumping syndrome occur over time. The transoral outlet reduction (TORe) procedure using an endoscopic suturing device may be an option to treat these conditions. We aimed to analyze outcome parameters and long-term results for this endoscopic technique. Methods A retrospective data analysis of patients who underwent TORe using an endoscopic suturing system at our institution from January 2015 to December 2020 was performed. A total of 71 subjects were included. Forty-five patients received the intervention for weight regain, 9 for dumping syndrome and 17 for both. The primary endpoint was weight stabilization or weight loss for subjects with weight regain, and resolution of symptoms for those with dumping syndrome. Secondary endpoints were intraoperative complications, procedure time, length of hospital stay and diameter of gastrojejunal anastomosis 1 year post-intervention. Results The median size of the gastrojejunal anastomosis was estimated at 30 mm before intervention, and after performing a median of 3 endoscopic sutures, the median estimated gastrojejunal anastomosis width was reduced to 9.5 mm. Eight perioperative complications occurred. Overall mean follow-up was 26.5 months. All interventions achieved weight stabilization or weight loss or resolution of dumping symptoms within the first 3 months, 98.2% at 12 months, 91.4% at 24 months and 75.0% at 48 months. In 22/26 subjects a persisting improvement of dumping syndrome was achieved. Conclusions TORe is a safe and effective procedure in the treatment of patients with dumping syndrome after laparoscopic RYGB, the effect on weight stabilization is less significant. A prospective randomized trial should be conducted to compare the effects of TORe with other surgical methods like banding the gastrojejunal anastomosis.

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“Fast and furious”: Endoscopic gastrojejunostomy revision for treatment of dumping syndrome?

Badurdeen

Kumbhari

Gómez

2022

Gastrointestinal Endoscopy

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Evaluation of endoscopic gastrojejunostomy revision after Roux-en-Y gastric bypass for treatment of dumping syndrome

Cited by 9 publications

References 26 publications

Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction

Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction

Long-term results after transoral outlet reduction (TORe) of the gastrojejunal anastomosis for secondary weight regain and dumping syndrome after Roux-en-Y gastric bypass

“Fast and furious”: Endoscopic gastrojejunostomy revision for treatment of dumping syndrome?

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