Trans-oral outlet revision (TORe)

Trans-oral Outlet Revision (TORe) is an endoscopic procedure that is used to treat a GJ anastomosis that can occur in the long term after weight loss surgery.

Trans-oral outlet revision (TORe)

What is a GJ anastomosis?

Weight loss surgery (bariatric surgery) is often required for management of overweight and obesity. The most common surgical options used in Australia include the sleeve gastrectomy or the Roux-en-Y gastric bypass (RYGB).

Many studies have identified that patient can regain weight in the long-term following any bariatric surgery, which can occur for a variety of reasons.

In patients who have has RYGB, dilatation of the remnant stomach “pouch” and widening of the surgical join between the stomach and the intestine, known as the gastro-jejunostomy (GJ) anastomosis can result in loss of the fullness or satiety feeling. Widening of the anastomosis causes faster emptying of the stomach contents into the intestine, which can also result in dumping syndrome.

Surgical revision of the GJ anastomosis is considered technically very complex and carries risks of significant complications.

What is a TORe?

Many endoscopic therapies for revision of the GJ anastomosis have been developed over the recent years. One of these procedures is the Trans-oral Outlet Revision (TORe) procedure - where the GJ anastomosis diameter can be reduced in size to approximately 1cm. The aim is to slow down contents leaving the pouch and increasing the fullness or satiety feeling. This can re-capture weight loss when carefully combined with a multidisciplinary team approach.

(TORe) is performed as a same-day procedure under intravenous sedation or general anaesthesia. Dr Gupta uses a dedicated endoscopic suturing device following thermal treatment of the GJ anastomosis (see video below). It is a much safer procedure compared with revisional surgery and studies have shown excellent long term results in carefully selected patients. The procedure can be repeated down the track if required.

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REFERENCES

Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc. 2016 Apr;83(4):776-9. doi: 10.1016/j.gie.2015.08.039. Epub 2015 Sep 5. PMID: 26344204.

Vargas EJ, Bazerbachi F, Rizk M, Rustagi T, Acosta A, Wilson EB, Wilson T, Neto MG, Zundel N, Mundi MS, Collazo-Clavell ML, Meera S, Abu-Lebdeh HS, Lorentz PA, Grothe KB, Clark MM, Kellogg TA, McKenzie TJ, Kendrick ML, Topazian MD, Gostout CJ, Abu Dayyeh BK. Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc. 2018 Jan;32(1):252-259. doi: 10.1007/s00464-017-5671-1. Epub 2017 Jun 29. PMID: 28664438.

The information provided here is for general educational purposes only. If you would like to know if a Trans-oral outlet revision (TORe) is appropriate for your situation, please contact Sydney Gastroenterology & Liver Group.

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