Endoscopy 2018; 50(04): S57
DOI: 10.1055/s-0038-1637197
ESGE Days 2018 oral presentations
20.04.2018 – Bariatric endoscopy
Georg Thieme Verlag KG Stuttgart · New York

TRANSORAL OUTLET REDUCTION FOR WEIGHT REGAIN AFTER GASTRIC BYPASS: DOES ONLY SUTURING MATTER?

V Bove
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
I Boškoski
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
R Landi
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
G Gibiino
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
L Laterza
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
F Mangiola
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
A Tringali
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
P Familiari
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
V Perri
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
G Costamagna
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Enlargement of gastrojejunal anastomosis is associated with weight regain after Roux-en-Y-Gastric-Bypass (RYGB). Transoral Outlet Reduction (TORe) has proven safe and effective for treatment of weight regain. The objective was to evaluate the weight loss and quality of life after TORe.

Methods:

Patients with at least 50% of weight regain and enlarged gastric outlet after RYGB treated at our centre were retrospectively identified. TORe was performed with Overstitch (Apollo-Endosurgery), a full-thickness endoscopic suturing device. Before suturing the outlet rims were cauterized with pulsed Argon-Plasma-Coagulation on 40-Watts-1 l/min (VIO-300D, ERBE-Elektromedizin-GmbH). Telephonic follow-up was done at 1, 3, 6 and 12 months. The quality of life was evaluated according to the Quality-Of-Life-Scale (QOLS).

Results:

Forty-one patients (35-female, mean-age 43.7) underwent TORe from January-2015 to August-2017. Baseline mean BMI was 37.9 (range 31 – 50) and weight was 107.9 kg (range 77 – 132). Mean procedure time was 34 minutes (range 15 – 60) and a mean number of 2.3stitches per-patient were placed (range 2 – 4). After suturing the patency was tested with a gastroscope. There were 2 (4.9%) complications: one-patient developed fever due to a small retrogastric collection treated with antibiotics, one-patient had a gastric perforation that required urgent surgery.

Thirty-four patients completed the follow-up at 1, 3 and 6 months and twenty-five cases already reached the 12-month follow-up. Mean weight loss at 6-month was 18.5 kg (mean-BMI 31.4) while at 12-month was 19 kg (mean BMI 31.2). Only one patient regained weight. All the patients reported satiety after 1-month, which was confirmed by 56.1% (n = 23/41) of patients after 6-month and by 40% (n = 10/25) after 12-month. Over 50% had an improvement quality of life in terms of physical activity, relationships and dietary habits.

Conclusions:

In our experience TORe was a safe and effective procedure in patients with weight regain after RYGB, showing an improvement in patients’ quality of life.

Further clinical trials are needed to establish the role and correct timing of TORe.