Bariatric endoscopy

ID: 3526666 TUBULAR POUCHPLASTY TRANSORAL OUTLET REDUCTION (TTORE) IS SUPERIOR TO AND MORE DURABLE THAN TRADITIONAL TORE IN A LARGE COHORT STUDY Rabih Ghazi*, Eric J. Vargas, Serge Baroud, Karim T. Osman, Tala Mahmoud, Rami Abusaleh, Veeravich Jaruvongvanich, Daniel B. Maselli, Karen Grothe, Matthew Clark, Manpreet Mundi, omar ghanem, Todd A. Kellogg, Andres Acosta, John A. Martin, Andrew C. Storm, Barham K. Abu Dayyeh Background: Endoscopic suture reduction of the gastrojejunal anastomosis (GJ) is a minimally invasive approach to treat weight regain in patients with Roux-en-Y gastric bypass (RYGB). Traditional transoral outlet reduction (TORe) is focused on reducing the aperture of the gastrojejunal (GJ) anastomosis, while the tubular transoral pouchplasty outlet reduction (tTORe) approach consists of tabularization of the distal pouch utilizing an O-shape gastroplasty suturing pattern (Figure 1). Objective: The primary aim of this study was to compare the shortand long-term weight loss between TORe and tTORe. Methods: Retrospective analysis of a prospectively maintained database was conducted at a tertiary care bariatric center of excellence. The study included patients with history of RYGB who had an endoscopic revision by TORe or tTORe and had follow-up data in their electronic medical record. The primary outcome was % total body weight loss (%TBWL), defined as the percent body weight loss in relation to the patient’s weight at the time of the procedure. Results: A total of 131 patients were included (tTOReZ96, TOReZ35). Table 1 describes the baseline and procedural characteristics of the cohort. At 3, 9, 12, and 18 months, patients who had a tTORe achieved significantly higher % TBWL compared to those who underwent a TORe (8.7% vs 6.4%, pZ0.0431 at 3 months; 9.5% vs 4.6%, pZ0.0470 at 9 months; 7.7% vs 0.8%, pZ0.00927 at 12 months; 7.5% vs -2.1%, pZ0.0036 at 18 months). When compared to the procedure alone, concomitant use of weight loss medication did not result in significantly higher % TBWL except at 12 months for the tTORe group (13.7% vs 6.1%, pZ0.0400). The mean procedural time, including diagnostic portions of the procedure, was not significantly different between the tTORe and TORe groups (59.5 vs 53 minutes, pZ0.0730). Overall adverse events were low (3%) and similar between both groups (pZ0.3). These included 3 patients with refractory nausea and vomiting requiring endoscopic balloon dilation, and 1 patient with hematemesis (nZ1) managed with endoscopic clip hemostasis. Conclusion: The tTORe approach significantly enhances the efficacy and durability over traditional TORe without increasing procedural time or adverse events. w e b 4 C = F P O