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PROCEDURAL VARIATIONS AND CLINICAL OUTCOMES FOR PATIENTS UNDERGOING TRANSORAL OUTLET REDUCTION
Akash T. Khurana, Anthony Gallo
*, Leandro Sierra, Arjun Chatterjee, Waqqas Haroon, Renan Prado, Michael Cymbal, Mohamed Nadeem, Mohamad-Noor Abu-Hammour, Stephen A. Firkins, Erika Staneff, Bailey Flora, Roma Patel, Roberto Simons-Linares
Gastroenterology, Cleveland Clinic, Cleveland, OH
Background:
Roux-en-Y gastric bypass (RYGB) is an effective treatment for obesity, though a subset of patients experience weight regain (WR) following surgery. Gastrojejunal anastamosis (GJA) dilation is considered a significant factor in post-RYGB WR. Endoscopic transoral outlet reduction (TORe), whereby the GJA diameter is reduced via ablation and purse-string suturing, has emerged as a safe and effective non-surgical therapy to treat WR after RYGB. Currently, there is no standardized practice for adjunctive procedural variations when performing TORe. The aim of this study is to evaluate the effect of several procedural variations including application of a hemostatic gel matrix, reinforcing gastroplasty sutures, and use of periprocedural antibiotics on TORe outcomes.
Methods:
We conducted a retrospective cohort study of patients who underwent TORe at a large tertiary care center from September 2022 through September 2024. All patients ? 18 years of age with history of RYGB who underwent TORe procedure were included. Patients who had additional revisions after the initial procedure were excluded from the analysis. Primary outcomes included total body weight loss (TBWL), change in body mass index (BMI), infection rate, post-procedural hemorrhage and hospitalizations. The statistical analysis was completed using a two-sample t-test.
Results:
A total of 137 patients were included in the analysis. Median age at the time of TORe was 52 years. TBWL at 3, 6, and 12 months was 10.3%, 10.7%, and 10.2% (Table 1). 21 patients had complications within 30 days including hospitalizations (N=16), bleeding (N=4), and infection (N=2). Endoscopic hemostatic gel matrix was associated with a reduction in bleeding rates within 30 days (t= –2.04, p<0.05). 11 patients underwent revision for inadequate weight loss or weight regain. Gastroplasty was not associated with improved TBWL, BMI, complications, or rate of further TORe revision. Peri-procedural antibiotic use did not have a statistically significant impact on infection or hospitalization outcomes within 30 days (Table 2).
Conclusion:
Our study highlights the efficacy of TORe in management of WR post-RYGB. Use of a hemostatic gel matrix is shown to reduce post-procedural bleeding risk. Reinforcing with an additional gastroplasty suture(s) is not shown to improved TBWL, BMI, or rate of TORe revision. Peri-procedural antibiotics may not correlate with reduced risk of post-TORe infection rates. Further studies are needed to correlate our results.
Table 1: Baseline characteristics, TBWL and BMI at 3-, 6-, and 12-months post-TORe.
Table 2. Periprocedural interventions (i.e. gastroplasty, hemostatic gel matrix, antibiotics) and associated outcomes (TBWL, rate of TORe revision, bleeding, infection/sepsis, hospitalizations).
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