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
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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.
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.
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%.
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.
KeywordsRoux-en-Y gastric bypass (RYGB) Transoral outlet reduction (TORe) Endoscopic suturing Weight regain Dumping syndrome
Study conception and design: Schweitzer, Michael; Oberbach, Andreas; Kumbhari, Vivek; Fayad, Lea
Acquisition of data: Dunlap, Margo K.; Shah, Tazkia; Fayad, Lea
Analysis and interpretation of data: Raad, Micheal; Doshi, Jay; Oleas, Roberto; El Asmar, Margueritta, Fayad, Lea
Drafting of manuscript: Kumbhari, Vivek
Critical revision: Kalloo, Anthony N.; Khashab, Mouen A.; Steele, Kimberly; Magnussen, Thomas
Compliance with Ethical Standards
For this type of study formal consent is not required.
Informed consent does not apply.
Conflict of Interest
Mouen A Khashab is on the medical advisory board for Boston scientific and Olympus America and is a consultant for Boston scientific, Olympus America, and Medtronic.
Anthony N Kalloo is a founding member, equity Holder, and consultant for Apollo Endosurgery.
Vivek Kumbhari is a consultant for Medtronic, Reshape Lifesciences, Boston Scientific, and Apollo Endosurgery. He also receives research support from ERBE USA and Apollo Endosurgery.
All other authors declare that they have no conflict of interest.
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