Endoloop-Assisted Transoral Outlet Reduction: A Pilot Case-control Study of a New Therapeutic Intervention for Weight Regain After Roux-en-Y Gastric Bypass

Aims For patients with weight regain after after Roux-en-Y gastric bypass (RYGB), transoral outlet reduction (TORe) is conventionally done using full thickness suturing to reduce gastrojejunal anastomosis (GJA) size. However, affordability and availability remain the key limitations. We invented endoloop-assisted transoral outlet reduction (e-TORe) which used non-technically demanding and economical accessories to increase accessibility of bariatric endoscopy.

Methods This is a retrospective analysis of RYGB patients with weight regain who underwent e-TORe. A gender, age, and obesity class matched-cohort in 1:2 ratio who got only physician-directed lifestyle modification (P-LSM) was included as a control. The primary outcome was %total weight loss (TWL), %excess weight loss (EWL), and excess BMI (EBMIL) loss at 3 months.

Results 18 patients who experienced weight regain post RYGB were included. 6 patients (5 Males, median age 40, mean BMI 40.1±7.7 kg/m²) underwent e-TORe. Compared to the matched-control group of 12 patients who received only P-LSM, e-TORe has shown significantly higher %TWL (6.69±4.98 vs -1.00±3.99%; p=0.021), %EWL (25.60±23.36 vs -3.38 ±12.95%; p=0.047), %EBMIL (25.79±23.33 vs -3.39±12.81%; p=0.046) at 3-month. After e-TORe mean GJA size (SD) was reduced from 1.87±0.75 cm to 6 mm. One patient who got uninteneded GJA reduction to 4 mm had marked vomiting which improved by prokinetic.

Conclusions For RYGB patients with weight regain, e-TORe is a safe and effective endoscopic procedure with less cost and complexity compared to conventional TORe. Still,long-term weight reduction efficacy remains to be determined.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023