Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
August 21, 2026 · via Europe PMC
Endoscopic transoral outlet reduction for weight recurrence after Roux-en-Y gastric bypass: a retrospective single-center analysis.
Da Canal F, Di Pietro Martinelli C, Potoczna N, +5 more, Delko T.
AI summary — for doctors, generated from the abstract only
Endoscopic outlet reduction narrowed the gastrojejunal anastomosis well but gave little average weight loss, though it helped dumping symptoms.
What was studied
Retrospective single-centre analysis of 93 patients (2012-2024) who had transoral outlet reduction for weight regain after Roux-en-Y bypass, using suturing, over-the-scope clips or combinations.
Key findings
- Anastomosis diameter fell from 25.0 to 10.7 mm.
- Mean %TWL was 1.1% and 42.7% kept gaining weight.
- Dumping symptoms remitted in 61.9% at 12 months.
Clinical relevance
TORe may be more useful for dumping syndrome and anatomical stabilisation than as stand-alone weight-loss therapy.
Who should care
Limitations
Retrospective, single-centre, with 80.6% follow-up at 12 months and no control group; the comparison of techniques is not reported in the abstract.
Offer TORe mainly for anastomotic dilation with dumping, and set realistic weight-loss expectations.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Purpose
Weight recurrence after Roux-en-Y gastric bypass affects 25% of patients. Gastrojejunal anastomosis dilation is a modifiable contributor. This study evaluates the efficacy and safety of endoscopic transoral outlet reduction (TORe), comparing suturing vs 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 a combination of techniques. Outcomes included percentage total body weight loss (%TWL) and symptomatic remission of dumping syndrome at 3, 6, 12, and 24 months, with 12 months as the primary reference time point (80.6% follow-up). Additional outcomes included technical success and 30-day adverse events.
Results
Ninety-three patients were included (47.3 ± 11.5 years; 81.7% female). Techniques used were: suturing, n = 48 (51.6%); OTSC, n = 33 (35.5%); combined, n = 8 (8.6%); and Bariatric Anastomotic Repair System, n = 4 (4.3%). Baseline body mass index was 32.6 ± 5.4 kg/m². Mean gastrojejunal anastomosis diameter was reduced from 25.0 ± 7.0 mm to 10.7 ± 2.1 mm (P <.001), with a technical success rate of 97.8%. At 12 months, %TWL was 1.1 ± 6.4% (Suturing: -0.1 ± 5.4% vs 1.5 ± 6.4%; P =.61). Among 47 patients (50.5%) with dumping syndrome, symptomatic remission was achieved in 74.4% at 3 months and in 61.9% at 12 months. The suturing group (n = 23) achieved 89.5% symptomatic remission at 3 months and 71.4% at 12 months, vs the OTSC group (n = 21), which achieved 60.0% and 52.4%, respectively (12-month odds ratio, 2.27; 95% CI, 0.71-7.84; P =.341). The adverse event rate was 6.5%.
Conclusion
TORe achieves excellent anatomical reduction. Although weight outcomes were heterogeneous (mean %TWL was 1.1%; 42.7% experienced continued weight gain), dumping syndrome symptomatic remission was substantial (61.9% at 12 months), supporting TORe as an anatomical stabilization measure within multidisciplinary obesity management rather than a standalone weight-loss intervention.
DOI
10.1016/j.gassur.2026.102560
PMID
42628593
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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