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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; Simsek, Cem; Oleas, Roberto; Dunlap, Margo K.; Shah, Tazkia; Doshi, Jay; El Asmar, Margueritta; Oberbach, Andreas; Singh, Vikesh K.; Steele, Kimberley; Magnussen, Thomas; Kalloo, Anthony N.; Khashab, Mouen A.; Kumbhari, Vivek


Obesity surgery 29 (2019), No.7, pp.2225-2232
ISSN: 0960-8923 (Print)
ISSN: 1708-0428 (Online)
Journal Article
Fraunhofer IZI ()

Background and Aims: Transoral outlet reduction (TORe) by devitalization and/or endoscopic suturing (ES) has been implemented in the management of weight regain post-RYGB. This study aims to assess the efficacy and safety of TORe following an insurance-based algorithm.
Methods: A prospectively maintained database of patients who underwent TORe between September 2015 and January 2018 at a single academic center was reviewed. An algorithm was followed whereby management was based on insurance coverage. As part of the algorithm, all patients presented for a repeat endoscopy at 8 weeks. Patients did not receive any diet, lifestyle intervention, or pharmacotherapy.
Results: In total, 55 patients were included (median age 48 years), out of which 50 were females (90.9%). Patients presented for evaluation at a mean of 8.7 years post-RYGB. The main presenting symptom was combined dumping syndrome (DS) and weight regain (49.1%), followed by weight regain alone (45.5%). Twenty-nine patients required treatment at their second procedure, and 11 required treatment at their third procedure. Average percent total body weight loss (%TBWL) after TORe observed at 3-, 6-, 9-, and 12-month follow-up was 8.2, 9.3, 8.4, and 5.5%, respectively. The mean DS Severity Score was significantly reduced from 23.3 ± 12.4 before TORe to 16.3 ± 6.51 after TORe (p < 0.01). The adverse event rate from TORe was 14.5%.
Conclusion: TORe is effective in halting ongoing weight regain and achieving moderate short-term weight loss as well as improving DS in post-RYGB patients. Durability at 1 year remains questionable due to weight recidivism.