Transoral outlet reduction: a comparison of purse-string with interrupted stitch technique

Abstract

TORe is effective in treatment of weight regain after failed gastric bypass. The purse-string technique results in greater weight loss at 12 months than the traditional interrupted suture pattern.

Endoscopic Management of Weight Regain

“…There is also some evidence to support that reinforcement suturing in the distal pouch is important, whereas suturing in the pouch with the intention of reducing pouch volume may not be as important to achieve clinical success. Studies have demonstrated that reduction of the GJA size is more important than a decrease in pouch volume [4,20,21]. When pouch sutures are performed, placement is typically aided by the tissue helix, an accessory device to the OverStitch system used to acquire tissue through rotation of a helical coil [17].…”

“…Although diet and lifestyle factors play a role in weight regain, anatomic changes undoubtedly contribute [4][5][6][7][8]. Previous studies have demonstrated that a dilated GJA aperture is an independent predictor of weight regain with a linear association ( Fig.…”

Endoscopic bariatric and metabolic therapies: Another tool for the management of diabetes and obesity

“…At the 1‐year follow‐up, another study demonstrated that TORe performed with full‐thickness suturing produced an EWL of 24.9 ± 2.6%, and weight loss was largely sustained at the 3‐year follow‐up . In an effort to further improve the procedure, two studies reported increased weight loss when full‐thickness sutures were placed in a purse‐string fashion compared with interrupted sutures …”

“…61 In an effort to further improve the procedure, two studies reported increased weight loss when full-thickness sutures were placed in a purse-string fashion compared with interrupted sutures. 62,63 The most common adverse events were nausea, vomiting, constipation, and pharyngolaryngeal pain, which were all most pronounced postoperatively. 58 Serious adverse events included gastrointestinal bleeding and stenosis at the gastrojejunal stoma.…”

Training in Bariatric and Metabolic Endoscopic Therapies

“…TORe using the interrupted suture pattern is less technically demanding and may be useful early in the learning curve [ 13 , 15 ]. However, more recent studies showed that TORe using a purse string suture technique appears to be able to induce more weight loss compared to interrupted suture technique [ 28 - 30 ]. Therefore, the trainee should learn to become comfortable at performing both techniques.…”