BACKGROUND AND AIMS Although traditional transoral outlet reduction (TORe) involves argon plasma coagulation (APC) before endoscopic suturing, modified endoscopic submucosal dissection (ESD) has also been used. This study aims to evaluate the safety and efficacy of modified ESD-TORe in comparison with traditional APC-TORe. METHODS This was a retrospective study of prospectively collected data from patients who underwent modified ESD-TORe and APC-TORe for weight regain after Roux-en-Y gastric bypass (RYGB). Our outcomes were technical success, adverse events as categorized by the American Society for Gastrointestinal Endoscopy lexicon, and percent total weight loss (TWL) at 6 and 12 months and patients who underwent ESD-TORe were matched 1:3 based on gastrojejunal anastomosis (GJA) and pouch sizes to those who underwent APC-TORe. TWL between groups was compared. A linear regression was performed to control for any confounders. RESULTS Nineteen RYGB patients underwent ESD-TORe. Technical success rate was 100%, with no severe adverse events. At 6 and 12 months, patients experienced 13.4% ± 6.6% and 12.1% ± 9.3% TWL, respectively (P < .05 for both). Nineteen ESD-TORe patients were also matched with 57 APC-TORe patients based on GJA and pouch sizes. At 12 months, the ESD-TORe group experienced greater weight loss compared with the APC-TORe group (12.1% ± 9.3% vs 7.5% ± 3.3% TWL, respectively; P = .036). On regression analysis, ESD remained a significant predictor of percent of TWL at 12 months after controlling for age, sex, body mass index, weight regain, and years from RYGB (β = 5.99, P = .02). CONCLUSIONS Combining endoscopic tissue dissection with suturing provides greater and more durable weight loss for patients with weight regain after RYGB.

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内镜下黏膜下剥离缝合术治疗胃搭桥术后体重恢复：结果与传统经口出口减少的比较（视频）。

背景与目的尽管传统的经口出口减少术（TORe）涉及在内窥镜缝合之前进行氩气血浆凝结（APC），但也已使用改良的内窥镜黏膜下剥离术（ESD）。这项研究旨在评估与传统的APC-TORe相比，改良的ESD-TORe的安全性和有效性。方法这是一项回顾性研究，收集了经过改良的ESD-TORe和APC-TORe进行Roux-en-Y胃旁路手术（RYGB）后体重恢复的患者的前瞻性收集数据。我们的结果是技术成功，按照美国胃肠内镜协会词汇分类的不良事件，以及在6和12个月时总体重减轻百分比（TWL），并且根据胃肠空肠吻合术（GJA）对接受ESD-TORe治疗的患者进行了1：3匹配）和小袋尺寸（适合接受APC-TORe手术的患者）。比较各组之间的TWL。进行线性回归以控制任何混杂因素。结果19例RYGB患者接受了ESD-TORe治疗。技术成功率为100％，无严重不良事件。在6个月和12个月时，患者的TWL分别为13.4％±6.6％和12.1％±9.3％（两者均P <.05）。根据GJA和袋大小，还对19名ESD-TORe患者和57名APC-TORe患者进行了匹配。与APC-TORe组相比，在12个月时，ESD-TORe组的体重减轻更大（分别为TWL的12.1％±9.3％和TWL的7.5％±3.3％； P = .036）。在回归分析中，在控制了年龄，性别，体重指数，体重恢复和RYGB的年限之后，在12个月后，ESD仍是TWL百分比的重要预测指标（β= 5.99，P = .02）。