Background

Roux-en-Y gastric bypass is the gold standard procedure for morbid obesity, with the most common complications of weight regain and gastrojeunal anastomosis (GJA) widening. Endoscopic trans-oral outlet reduction (TORe) is a safe, technically feasible, and durable treatment for revision of GJA enlargement. The objective of this study is to demonstrate that TORe is an effective alternative to surgical correction of GJA widening, with fewer adverse events (AEs).

Methods

We conducted a comprehensive review of several databases to identify relevant articles. We then performed a retrospective chart review of 65 patients who underwent TORe with the primary outcomes of total weight loss (TWL) at 1, 3 and 5 months and adverse events.

Results

Six prospective and retrospective studies and one systematic review were included, involving 1778 patients undergoing TORe. TORe was correlated with weight loss as early as 3 months and as long as 7 years post-procedure. There was no significant difference in weight loss between endoscopic and surgical correction of GJA widening. The technical success rate was 99.89-100% with no serious AEs and an overall AE rate of 6.5-11.4%. In our 65 patient sample, TWL at 1, 3 and 5 months post TORe of 16.06+/-9.17, 25.34+/-12.79, and 30.22+/-12.91 respectively. There were no serious AEs reported, with the most common AE being the need for a second TORe (4 patients, 6.06%).

Conclusions

TORe is a safe and technically practical option for GJA outlet reduction after gastric bypass, and may offer weight loss without the risks of more invasive surgical revisions.