Poster 186: Endoscopic Trans-Oral Outlet Reduction in Combination with Gastroplasty (TORe-G) Is a Novel Technique That Is Highly Efficacious and Safe for Weight Loss in Patients With Failed Roux-en-Y Gastric Bypass (RYGB)
Author Insight from Deepinder Goyal, MD, UCLA Division of Digestive Diseases
What’s new here and important for clinicians?
Several endoscopic suturing strategies have been described as revision therapies for weight regain after gastric bypass (RYGB) surgery. Although evidence exists regarding outcomes of trans-oral GJ outlet reduction (TORe) in terms of weight loss, the efficacy of gastric pouch revision is still unclear. Using a full thickness endoscopic suturing device, we demonstrated the efficacy and safety of a novel combined approach of endoscopic GJ stoma revision and gastroplasty of the entire gastric pouch from the gastro-esophageal junction to the GJ stoma (TORe-G) for induction of weight loss in the setting of weight regain after RYGB failure.
TORe-G resulted in greater weight loss as compared to published data on GJ stoma revision alone. The percentage of excess weight loss (EWL) observed in our study (n=20) was above 50% at 6 months as compared to approximately 12-20% reported with TORe alone. Corresponding total weight loss was also robust at 8.5% at median 4.5 months duration of follow-up. Furthermore, we observed a continuous trend of significantly higher weight loss (13%) even at 9 month post-TORe-G. We hypothesize that the greater weight loss observed with our technique may be secondary to greater gastric volume restriction, reduced gastric emptying times, and higher baro-receptor stimulation of stretch receptors thereby inducing satiety.
What do patients need to know?
In the last decade, a tremendous surge is seen in patients encountering weight relapse as a medically challenging and emotionally frustrating problem. Enlargement of the remnant gastric pouch and/or gastro-jejunal (GJ) stoma post-surgery have been demonstrated to be associated with weight regain. Due to the risks and complexity of surgical revision, several endoscopic suturing techniques and platforms have been developed that provide both a minimally invasive and safe approach for revision of failed gastric bypass surgery. We believe that gastric pouch volume restoration in addition to GJ outlet reduction have an additive effect to help achieve greater and more sustained weight loss in patients with weight regain or RYGB failure. We have demonstrated the efficacy and safety of a novel combined approach of endoscopic trans-oral outlet reduction in combination with gastroplasty of the entire gastric pouch (TORe-G) to re-establish weight loss in patients with failed RYGB using a full thickness endoscopic suturing device.
Author Contact Deepinder Goyal, MD, UCLA Division of Digestive Diseases
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