Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery

Christopher C. Thompson, Bipan Chand, Yang K. Chen, Daniel C. Demarco, Larry Miller, Michael A Schweitzer, Richard I. Rothstein, David B. Lautz, James Slattery, Michele B. Ryan, Stacy Brethauer, Phillip Schauer, Mack C. Mitchell, Anthony Starpoli, Gregory B. Haber, Marc F. Catalano, Steven Edmundowicz, Annette M. Fagnant, Lee M. Kaplan, Mitchell S. Roslin

Research output: Contribution to journalArticle


Background & Aims: Weight regain or insufficient loss after Roux-en-Y gastric bypass (RYGB) is common. This is partially attributable to dilatation of the gastrojejunostomy (GJ), which diminishes the restrictive capacity of RYGB. Endoluminal interventions for GJ reduction are being explored as alternatives to revision surgery. We performed a randomized, blinded, sham-controlled trial to evaluate weight loss after sutured transoral outlet reduction (TORe). Methods: Patients with weight regain or inadequate loss after RYGB and GJ diameter greater than 2 cm were assigned randomly to groups that underwent TORe (n = 50) or a sham procedure (controls, n = 27). Intraoperative performance, safety, weight loss, and clinical outcomes were assessed. Results: Subjects who received TORe had a significantly greater mean percentage weight loss from baseline (3.5%; 95% confidence interval, 1.8%-5.3%) than controls (0.4%; 95% confidence interval, 2.3% weight gain to 3.0% weight loss) (P =.021), using a last observation carried forward intent-to-treat analysis. As-treated analysis also showed greater mean percentage weight loss in the TORe group than controls (3.9% and 0.2%, respectively; P =.014). Weight loss or stabilization was achieved in 96% subjects receiving TORe and 78% of controls (P =.019). The TORe group had reduced systolic and diastolic blood pressure (P

Original languageEnglish (US)
Issue number1
Publication statusPublished - Jul 2013



  • Dilated Anastomosis
  • Endocinch
  • Overstitch
  • Stomaphyx

ASJC Scopus subject areas

  • Gastroenterology

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