Comparison of a superficial suturing device with a full-thickness suturing device for transoral outlet reduction (with videos)

Background: Larger gastrojejunal (GJ) anastomosis aperture is one independent predictor for weight regain after Roux-en-Y gastric bypass. Transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain by using a superficial-thickness (ST) suturing device. Full-thickness (FT) suturing devices are now available, potentially providing more effective results. Objective: To compare effectiveness of superficial-thickness with full-thickness TORe. Design: Matched cohort study: patients were matched sequentially by GJ anastomosis aperture, body mass index, and age. Setting: Tertiary-care center. Patients: A total of 59 consecutive patients undergoing full-thickness TORe were matched with 59 patients undergoing superficial-thickness TORe. All had GJ anastomosis apertures > 20 mm. Intervention: Transoral outlet reduction. Main Outcome Measurements: Weight loss and rate of adverse events. Results: Post-TORe GJ anastomosis apertures were similar between groups (ST 6.9 +/- 0.2 mm vs FT 7.1 +/- 0.3 mm). Weight loss was greater at 6 months in the FT group (10.6 +/- 1.8 kg in FT vs 4.4 +/- 0.8 kg in ST; P < .01) and at 1 year (8.6 +/- 2.5 kg in FT vs 2.9 +/- 1.0 kg in ST; P < .01). Excess weight loss was greater in the FT group at 6 months (20.4 +/- 3.3% in FT vs 8.1 +/- 2.5% in ST; P < .01) and at 1 year (18.9 +/- 5.4% in FT vs 9.1 +/- 2.3% in ST; P = .03). Limitations: This was a single-center, retrospective, cohort study. Conclusion: There is level 1b evidence for effectiveness of TORe by using a superficial mucosal suturing device. This matched cohort study compared TORe by using the same ST suturing device with TORe by using a newer, FT suturing device and the same operative methods. FT TORe resulted in significantly more weight loss than ST TORe at 6 months and at 1 year. Full-thickness TORe is a significant improvement over ST TORe for endoscopic therapy of weight regain in patients with dilated GJ anastomosis.