Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?

Abstract

Background and study aim: Significant weight regain affects up to a third of patients after Roux-en-Y Gastric Bypass (RYGB) and demands treatment. The transoral outlet reduction (TORe) with Argon Plasma Coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short. However, no study has investigated the course of the gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedural year. Patients and methods: Patients eligible for a 36-month follow-up visit after TORe underwent upper GI endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJA size. Comparisons between APC and APC-FTS TORe were a secondary aim. Results: Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to preprocedural levels. Only the energy/fatigue domain improvement was kept between the one and 3-year visits. Conclusions: Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered an iterant rather than a one-off procedure.

Endoscopic revision of one-anastomosis gastric bypass (ER-OAGB) for weight recurrence: a case series of 17 adults

“…Pouch length was measured via standard scope markings, and GJA diameter was estimated visually relative to the endoscope and/or endoscopic tools, as is standard practice in TORe. 30,31 If present, visible surgical material was removed from the GJA with forceps and/or endoscopic scissors. If no contraindications to ER-OAGB were identified, gastric tissue surrounding the GJA was circumferentially ablated using argon plasma coagulation (80 W, 1.2 L/min) for a golden-brown effect approximately 5–10 mm in width.…”

Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

“…First, an endoscopic evaluation with a single-channel gastroscope was performed to identify anatomy, including the gastric pouch, GJA, and blind and efferent limbs of the jejunum. TORe diameter was estimated by standard foreign body forceps, as implemented in guidelines and studies of TORe[ 17 , 18 ]. If present, visible surgical material was removed from the GJA with forceps and/or endoscopic scissors.…”