Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up

Background and Aims: Dilated gastrojejunal anastomosis aperture is associated with weight regain after Roux-en-Y gastric bypass (RYGB). Transoral outlet reduction (TORe) has proved safe and effective for the treatment of weight regain. The objective of this study was to determine the long-term weight trend and number needed to treat for TORe. Methods: This prospective series included consecutive post-RYGB patients with weight regain and a gastrojejunal anastomosis aperture greater than 15 mm. TORe was performed with a full-thickness endoscopic suturing device. Results: A total of 150 patients who had regained 49.9% +/- 3.6% of the weight lost after gastric bypass (4.1 +/- 0.3 kg/y after nadir) before TORe. At TORe, body mass index was 40.2 +/- 0.8 kg/m(2) and weight was 110.7 +/- 2.2 kg. At 1 year, weight loss was 10.5 +/- 1.2 kg or 24.9 +/- 2.6% excess weight loss (EWL); at 2 years, weight loss was 9.0 +/- 1.7 kg or 20.0% +/- 6.4% EWL; at 3 years, weight loss was 9.5 +/- 2.1 kg or 19.2% +/- 4.6% EWL. The number needed to treat for arrest of weight regain was 1.0 at 6 months, 1.1 at 1 year, and 1.2 at 2 and 3 years. The number needed to treat to maintain weight loss of >= 5 kg from TORe was 1.2 at 6 months, 1.5 at 1 year, 1.9 at 2 years, and 2.0 at 3 years. Conclusion: TORe safely and effectively arrested weight regain and provided durable weight loss with a low number needed to treat. Patients with weight regain after RYGB should be evaluated for dilation of the gastrojejunal anastomosis, as TORe can be part of a multidisciplinary strategy to address post-RYGB weight regain.