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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(05): E538-E545
DOI: 10.1055/a-2075-1198
Original article

Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?

Vitor Ottoboni Brunaldi 
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
2   Mayo Clinic, Gastroenterology and Hepatology Department, Rochester, Minnesota, United States
,
Guilherme Henrique Peixoto de Oliveira 
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
,
Anthony Kerbage 
2   Mayo Clinic, Gastroenterology and Hepatology Department, Rochester, Minnesota, United States
,
Pedro Henrique Ribas
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
,
Felipe Nunes
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
,
Galileu Faria 
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
,
Diogo de Moura 
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
,
Daniel Riccioppo
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
,
Marco Santo
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
,
Eduardo de Moura 
1   University of Sao Paulo Faculty of Medicine, Gastrointestinal Endoscopy Unit, Gastroenterology Department, Sao Paulo, Brazil
› Author Affiliations TRIAL REGISTRATION: Extended follow-up study for a RCT NCT03094936 at ClinicalTrials.gov
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Abstract

Background and study aims Significant weight regain affects up to one-third of patients after Roux-en-Y gastric bypass (RYGB) and demands treatment. Transoral outlet reduction (TORe) with argon plasma coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short term. However, no study has investigated the course of gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedure year.

Patients and methods Patients eligible for a 36-month follow-up visit after TORe underwent upper gastrointestinal endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJ anastomosis (GJA) size. Comparisons between APC and APC-FTS TORe were a secondary aim.

Results Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to pre-procedure levels. Only the energy/fatigue domain improvement was kept between the 1- and 3-year visits.

Conclusions Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered iterative rather than a one-off procedure.



Publication History

Received: 17 February 2023

Accepted after revision: 14 April 2023

Accepted Manuscript online:
17 April 2023

Article published online:
26 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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