Endoscopy 2018; 50(04): S57
DOI: 10.1055/s-0038-1637195
ESGE Days 2018 oral presentations
20.04.2018 – Bariatric endoscopy
Georg Thieme Verlag KG Stuttgart · New York

TRANSORAL OUTLET REDUCTION (TORE) BY ENDOSCOPIC SUTURING IN PATIENTS WITH WEIGHT REGAIN AFTER ROUX-EN-Y GASTRIC BYPASS. PRELIMINARY OUTCOMES OF FEASIBILITY, EFFICACY AND SAFETY

S Bacchiddu
1   Hospital Universitario Dexeus, Barcelona, Spain
,
E Espinet Coll
1   Hospital Universitario Dexeus, Barcelona, Spain
,
J Nebreda Duran
2   Endosmedicina. Diagonal Clinic, Barcelona, Spain
,
G López-Nava Breviere
3   University Sanchinarro Hospital, Madrid, Spain
,
M Galvao-Neto
4   GastroObeso Center, Sao Paolo, Brazil
,
P Diaz Galan
1   Hospital Universitario Dexeus, Barcelona, Spain
,
JA Gómez Valero
1   Hospital Universitario Dexeus, Barcelona, Spain
,
C Vila Lolo
1   Hospital Universitario Dexeus, Barcelona, Spain
,
I Bautista-Castaño
3   University Sanchinarro Hospital, Madrid, Spain
,
A Juan-Creix Comamala
1   Hospital Universitario Dexeus, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 
 

    Aims:

    The aim of this study was to evaluate the technical feasibility, and safety and efficacy outcomes, in the short-medium term, of transoral outlet reduction (TORe), by means of an endoscopic suture device in patients with weight regain after Roux-en-Y gastric bypass (RYGB).

    Methods:

    Bariatric surgery remains the most effective long-term therapeutic option for morbid obesity. Over time, however, many of these patients can regain much of their lost weight.

    This was a retrospective, descriptive multicentric analysis of 15 consecutive patients submitted for weight regain after RYGB and with dilated gastro-jejunal anastomosis (> 15 mm). TORe was performed using an endoscopic transmural suture device (OverStitch-Apollo®) which was used to reduce the anastomosis aperture and also to treat the gastric pouch when it was dilated (> 5 cm). We describe intraoperative technical data, and safety and weight loss outcomes with a follow-up at 1, 3 and 6 month.

    Results:

    After RYGB, there was a mean maximum weight loss of 37.69 kg and a later average regain of 21.62 kg. Mean anastomosis diameter was 36 mm (range 20 – 45) which was reduced to 9 mm (range 5 – 12) (75% reduction) with an average of 2.5 sutures (2 – 3). Mean pouch size was 7.2 cm (range 2 – 10) which decreased to 4.7 cm (range 4 – 5) (34.72% reduction) in 11/13 patients with an average of 2.7 sutures (0 – 4).

    Mean weight loss at 1, 3 and 6 months after TORE was 6.19 kg, 10.06 kg and 12.29 kg, representing a weight loss of 28.63%, 46.53% and 56.85% of weight regained after RYGB. The procedure proved safe in all cases.

    Conclusions:

    Endoscopic suture reduction of the dilated gastro-jejunal anastomosis and the gastric pouch seems a feasible and safe option. Within a multidisciplinary approach and in a short-medium term follow-up, it is presented as a minimally invasive and effective option to control weight regain after RYGB.


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