Endoscopic Transoral Outlet Reduction for Weight Recurrence After Roux-en-Y Gastric Bypass: A Retrospective Single-Center Analysis
In brief
Endoscopic outlet reduction resolves dumping symptoms in about six of ten patients
In 93 post-bypass patients, transoral outlet reduction shrank the gastrojejunal opening by two-thirds and led to dumping-syndrome remission in 61.9% at one year, while average weight loss was only 1.1% total body weight. Technical success was 98% with a 6.5% adverse-event rate, suggesting the procedure stabilizes anatomy rather than serves as a primary weight-loss tool.
- Journal
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (Q1)
- Published
- 21 August 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- F Da Canal, C Di Pietro Martinelli, N Potoczna, N Wiegand, G Peros, W Gantert, et al.
- PMID
- 42628593
- DOI
- 10.1016/j.gassur.2026.102560
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 26 August 2026): TORe for weight recurrence after gastric bypass
Abstract
PURPOSE: Weight recurrence after Roux-en-Y gastric bypass affects 25% of patients. Gastrojejunal anastomosis dilation is a modifiable contributor. This study evaluates endoscopic transoral outlet reduction (TORe) efficacy and safety, comparing suturing versus over-the-scope clips (OTSC). METHODS: Retrospective analysis of consecutive patients undergoing TORe for weight recurrence (2012-2024) at a tertiary center. Treatments included endoscopic suturing (OverStitch, Boston Scientific), OTSC, or combined techniques. Outcomes included %TWL and dumping syndrome symptomatic remission at 3, 6, 12, and 24 months, with 12 months as the primary reference timepoint (80.6% follow-up). Additional outcomes: technical success and 30-day adverse events. RESULTS: Ninety-three patients were included (47.3±11.5 years; 81.7% female). TECHNIQUES: suturing n=48 (51.6%), OTSC n=33 (35.5%), combined n=8 (8.6%), BARS n=4 (4.3%). Baseline BMI 32.6±5.4kg/m². Mean GJA diameter reduced from 25.0±7.0mm to 10.7±2.1mm (p<0.001), technical success 97.8%. At 12 months, %TWL was 1.1±6.4% (Suturing: -0.1±5.4% vs 1.5±6.4%, p=0.61). Among 47 patients (50.5%) with dumping syndrome, symptomatic remission was achieved in 74.4% at 3 months and 61.9% at 12 months. Suturing group (n=23) achieved 89.5% symptomatic remission at 3 months and 71.4% at 12 months versus OTSC group (n=21) 60.0% and 52.4% respectively (12-month OR=2.27, 95%CI 0.71-7.84, p=0.341). Adverse event rate was 6.5%. CONCLUSION: TORe achieves excellent anatomical reduction. Although weight outcomes were heterogeneous (mean %TWL 1.1%; 42.7% experienced continued weight gain), dumping syndrome symptomatic remission was substantial (61.9% at 12 months), supporting TORe as anatomical stabilization within multidisciplinary obesity management rather than a standalone weight loss intervention.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.