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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

  • Lea Fayad
  • Michael Schweitzer
  • Micheal Raad
  • Cem Simsek
  • Roberto Oleas
  • Margo K. Dunlap
  • Tazkia Shah
  • Jay Doshi
  • Margueritta El Asmar
  • Andreas Oberbach
  • Vikesh K. Singh
  • Kimberly Steele
  • Thomas Magnussen
  • Anthony N. Kalloo
  • Mouen A. Khashab
  • Vivek KumbhariEmail author
Original Contributions
  • 32 Downloads

Abstract

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.

Keywords

Roux-en-Y gastric bypass (RYGB) Transoral outlet reduction (TORe) Endoscopic suturing Weight regain Dumping syndrome 

Notes

Author Contributions

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

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

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.

Supplementary material

11695_2019_3828_MOESM3_ESM.mp4 (366.6 mb)
Video 3 APC application to a GJA at follow-up EGD post-TORe with ES-APC (MP4 375,433 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Lea Fayad
    • 1
  • Michael Schweitzer
    • 1
  • Micheal Raad
    • 1
  • Cem Simsek
    • 1
  • Roberto Oleas
    • 1
  • Margo K. Dunlap
    • 1
  • Tazkia Shah
    • 1
  • Jay Doshi
    • 1
  • Margueritta El Asmar
    • 1
  • Andreas Oberbach
    • 2
  • Vikesh K. Singh
    • 1
  • Kimberly Steele
    • 1
  • Thomas Magnussen
    • 1
  • Anthony N. Kalloo
    • 1
  • Mouen A. Khashab
    • 1
  • Vivek Kumbhari
    • 1
    Email author
  1. 1.Johns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Department of DiagnosticsFraunhofer Institute for Cell Therapy and ImmunologyLeipzigGermany

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