Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence

Donna Maria Abboud; Rabih Ghazi; Vitor Brunaldi; Khushboo Gala; Serge Baroud; Anthony Kerbage; Farah AbdulRazzak; Karim Al Annan; Babusai Rapaka; Rebecca Yao; Eric J Vargas; Andrew C Storm; Barham K Abu Dayyeh

doi:10.1055/a-2117-8113

Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence

Endosc Int Open. 2023 Sep 15;11(9):E829-E834. doi: 10.1055/a-2117-8113. eCollection 2023 Sep.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States.
² Gastroenterology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Abstract

Background and study aims Traditional transoral outlet reduction (TORe) is a minimally invasive endoscopic approach focused on reducing the aperture of the gastrojejunal (GJ) anastomosis, while the tubular transoral outlet reduction (tTORe) consists of tabularization of the distal pouch utilizing an O-shape gastroplasty suturing pattern. The primary aim of this study was to compare short-term weight loss between TORe and tTORe. Patients and methods Retrospective analysis of a prospectively maintained database was conducted at a tertiary care bariatric center of excellence. The study included patients with history of Roux-en-Y gastric bypass (RYGB) who had an endoscopic revision by TORe or tTORe and had follow-up data in their electronic medical record. The primary outcome was percent total body weight loss (%TBWL). Results A total of 128 patients were included (tTORe=85, TORe=43). At 3 and 6 months, the tTORe and TORe cohorts presented similar %TBWL (3 months: 8.5±4.9 vs. 7.3±6.0, P = 0.27 and 6 months: 8.1±7.4 vs. 6.8±5.6, P = 0.44). At 9 months, there was a trend toward greater weight loss in the tTORe cohort (9.7±8.6% vs. 5.1±6.8%, P = 0.053). At 12 months, the %TBWL was significantly higher in the tubularization group compared to the standard group (8.2±10.8 vs. 2.3±7.3%, P = 0.01). Procedure time was significantly different between both groups (60.5 vs. 53.4 minutes, P = 0.03). The adverse events rate was similar between groups (8.2% vs. 7.0% for tTORe and TORe, respectively, P = 0.61). Conclusions The tTORe enhances efficacy and durability of the standard procedure without adding significant procedure-related risks.

Keywords: Endoscopic resection (ESD, EMRc, ...); Endoscopy Upper GI Tract; GI surgery; Other focus (of reviewers); RFA and ablative methods.

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