Back to 2025 Abstracts
TRANSORAL OUTLET REDUCTION FOR DUMPING SYNDROME AFTER ROUX-EN-Y GASTRIC BYPASS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Azizullah Beran
*1, Khaled Alsabbagh Alchirazi
2, Daryl Ramai
3, Abubaker Abdalla
4, Eugene Nwankwo
5, Mark A. Gromski
11Gastroenterology and Hepatology, Indiana University, Bloomington, IN; 2Aurora Health Care, Milwaukee, WI; 3Brigham and Women's Hospital, Boston, MA; 4University of Minnesota Twin Cities, Minneapolis, MN; 5Mayo Clinic Minnesota, Rochester, MN
Introduction: Dumping syndrome is one of the main complications of Roux-en-Y gastric bypass (RYGB) surgery. Transoral outlet reduction (TORe) is a minimally invasive endoscopic procedure that reduces the size of the gastrojejunal anastomosis (GJA) through ablation and endoscopic suturing, primarily used to address weight regain after RYGB. Emerging evidence highlights the feasibility and safety of TORe as a treatment for dumping syndrome that persists despite dietary modifications and medical therapy. This systematic review and meta-analysis aims to evaluate the efficacy and safety of TORe for managing dumping syndrome.
Methods: We conducted a comprehensive search of PubMed, Embase, and Web of Science databases from inception to November 2024. The primary outcomes were: clinical success and the mean difference in pre- and post-procedural Sigstad’s score assessments. Secondary outcomes included rates of post-procedural serious adverse events. Clinical success was defined as persistent symptom improvement without the need for repeat TORe or revisional surgery during the follow-up period. Pooled rate estimates and mean differences were calculated using random-effects models, and heterogeneity was evaluated with the I2 statistic.
Results: Five studies with a total of 235 post-RYGB patients with dumping syndrome were included. Female patients constituted 80% of the population, with a mean age of 45.6±11.4 years. In four studies reporting GJA size, the mean pre-procedural GJA size was 34.2±10.4 mm (n=177), reduced to 6.6±4.01 mm (n=62) post-TORe. Follow-up durations ranged from three to 24 months. Pooled clinical success was 82% (95% confidence interval [CI] 66%-92%, I
2=78%, Figure 1A). Furthermore, TORe resulted in a significant improvement in Sigstad’s score (mean difference of ?11.12 [95% CI -15.33 to ?6.91], P<0.001, I
2=89%, Figure 1B). The rate of serious adverse events was 4% (95% CI 1%-17%, I
2=68%, Figure 1C).
Conclusions: Our findings indicate that TORe is a safe and effective minimally invasive treatment option for dumping syndrome. Further research is warranted to compare the outcomes of TORe with those of revisional surgical procedures.
Figure 1
Back to 2025 Abstracts
