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REDO TRANSORAL OUTLET REDUCTION (RE-TORE): TECHNICAL FEASIBILITY AND MEDIUM-TERM OUTCOMES

Maria Valeria Matteo 1, Giorgio Carlino 1, Vincenzo Bove 1, Valerio Pontecorvi 1, Martina De Siena 1, Giulia Giannetti 1, Nausicaa Antonini 1, Chiara Massari 1, Laila Vinti 1, Giulia Polidori 1, Giulia Palumbo 1, Cristiano Spada 1, Guido Costamagna 1, Ivo Boskoski 1

Affiliations

1 Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Summary

AI Generated

A retrospective case series of 10 patients found that repeat transoral outlet reduction (redo TORe) was technically feasible without periprocedural complications and achieved weight loss and dumping syndrome improvement at 6 and 12 months after Roux-en-Y gastric bypass.

Of 92 patients who underwent TORe between January 2015 and October 2021, 10 required redo TORe for weight regain (3 patients) or both weight regain and dumping syndrome recurrence (7 patients).
Redo TORe was technically feasible in all 10 patients with no periprocedural adverse events reported.
Mean total body weight loss was 7.7% at 1 month, 10.1% at 6 months, and 10.1% at 12 months after redo TORe.
Among 6 patients with recurrent dumping syndrome who reached follow-up, 3 achieved complete remission maintained at 1 year, with statistically significant improvements in Sigstad's score (p=0.04) and early Arts Dumping Score (p=0.01).
The authors suggest that redo TORe should be considered before referring patients for revision surgery.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Weight regain and dumping syndrome (DS) are two relevant long term adverse events after Roux-en-Y Gastric Bypass (RYGB). Both these conditions are related to the dilation of the gastro-jejunal anastomosis. Transoral outlet reduction (TORe) is minimally invasive endoscopic procedure that was introduced to treat these conditions when medical treatment fails. As every endoscopic procedure, TORe is repeatable per definition. In this case series, we evaluate the technical feasibility and short and medium-term outcomes of the redo TORe in patients with weight regain and/or DS recurrence after primary TORe.

Aims & Methods

A retrospective analysis was done on a prospective database including patients that underwent TORe between January 2015 and October 2021; patients who received a re-TORe because of progressive loss of satiety and weight regain (≥50% of weight loss after primary TORe), or recurrence of DS were included in the analysis. DS recurrence was defined as Sigstad’s dumping score ≥7. Sigstad’s score, early and late Arts Dumping Score (ADS) questionnaires, and percentage of total body weight loss (%TBWL) were assessed at baseline, at 6 and 12 months after re-TORe.

Results

Of 92 patients that underwent TORe, 10 required a re-TORe. Indication to re-TORe was weight regain alone in 3 patients, while the remaining 7 repeated the procedure due to both DS recurrence and weight regain. The median time between the primary TORe and the re-TORe was 28 months (range 14-64 years). The median weight regain was 217% (IQR 400) compared to weight at primary TORe and 31.3 % (IQR 16) compared to weight at RYGB. The median Sigstad’s score for patients with recurrent DS was 14 (IQR 4.5), while median early ADS was 5 (IQR 9.5) and late ADS was 8 (IQR 3.5). The redo TORe was technically feasible in all patients. No periprocedural adverse events occurred. Mean percentage of total body weight loss (%TBWL) was 7.7% (IQR 2) at 1 month, 10.1% (IQR 14.2) at 6 months and 10.1% (IQR 18) at 12 months. 6/7 patients undergoing re-TORe because of recurrent DS reached 6- and 12-months follow-up. 3/6 patients had a complete remission of DS maintained at 1 year. Trends of symptoms-based questionnaire for DS are reported in table 1.

Dumping syndrome outcomes after re-TORe
	Baseline	6 months	12 months	P^#
Sigstad’s Score	14 (4.5)	7 (1-14)	4.5 (1-14)	0.04
EADS	5 (1-10.5)	4 (0-4)	4.5 (0-8)	0.01
LADS	8 (5.5-9)	3 (0-4)	2.5 (0-4)	0.06
^# Friedman test, Values are median (Q1-Q3) EADS= Early Arts Dumping Score questionnaire; LADQ= Late Arts Dumping Score questionnaire.

Conclusion

According to our experience, redo TORe is technically feasible and has good short and medium-term outcomes in terms of weight loss and DS control. As such, repeating the procedure should be considered before referring patients for revision surgery.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 04 Nutrition (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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The endoscopy academy lead nurse–strategy and outcomes

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