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

Obes Surg. 2019 Jul;29(7):2225-2232. doi: 10.1007/s11695-019-03828-1.


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

MeSH terms

  • Algorithms
  • Dumping Syndrome / epidemiology
  • Dumping Syndrome / surgery*
  • Female
  • Gastric Bypass / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Mouth / surgery
  • Natural Orifice Endoscopic Surgery / adverse effects
  • Natural Orifice Endoscopic Surgery / statistics & numerical data
  • Obesity, Morbid / surgery
  • Postoperative Complications / epidemiology
  • Postoperative Complications / surgery*
  • Prospective Studies
  • Reoperation / adverse effects
  • Reoperation / statistics & numerical data
  • Suture Techniques*
  • Treatment Outcome
  • Weight Gain / physiology*