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Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-12-07 , DOI: 10.1016/j.gie.2019.11.044 Pichamol Jirapinyo 1 , Nitin Kumar 2 , Mohd Amer AlSamman 3 , Christopher C Thompson 1
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-12-07 , DOI: 10.1016/j.gie.2019.11.044 Pichamol Jirapinyo 1 , Nitin Kumar 2 , Mohd Amer AlSamman 3 , Christopher C Thompson 1
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BACKGROUND AND AIMS
Transoral outlet reduction (TORe) is a common endoscopic treatment for patients with weight regain after Roux-en-Y gastric bypass (RYGB) with a dilated gastrojejunal anastomosis (GJA). This study aims to assess long-term efficacy of TORe.
METHODS
This was a retrospective review of prospectively collected data on RYGB patients who underwent TORe for weight regain or inadequate weight loss. The primary outcome was efficacy of TORe at 1, 3, and 5 years. Secondary outcomes were procedure details, safety profile, and predictors of long-term weight loss after TORe.
RESULTS
Three hundred thirty-one RYGB patients underwent 342 TORe procedures and met inclusion criteria. Of these, 331, 258, and 123 patients were eligible for 1-, 3- and 5-year follow-ups, respectively. Mean body mass index was 40 ± 9 kg/m2. Pre-TORe GJA size was 23.4 ± 6.0 mm, which decreased to 8.4 ± 1.6 mm after TORe. Patients experienced 8.5% ± 8.5%, 6.9% ± 10.1%, and 8.8% ± 12.5% total weight loss (TWL) at 1, 3, and 5 years with follow-up rates of 83.3%, 81.8%, and 82.9%, respectively. Of 342 TORe procedures, 76%, 17.5%, 4.4%, and 2.1% were performed using single purse-string, interrupted, double purse-string, and running suture patterns, respectively, with an average of 9 ± 4 stitches per GJA. Pouch reinforcement suturing was performed in 57.3%, with an average of 3 ± 2 stitches per pouch. There were no severe adverse events. Some patients (39.3%) had additional weight loss therapy (pharmacotherapy or procedure), with 3.6% getting repeat TORe. Amount of weight loss at 1 year (β = .43, P = .01) and an additional endoscopic weight loss procedure (β = 8.52, P = .01) were predictors of percentage of TWL at 5 years.
CONCLUSIONS
TORe appears to be safe, effective, and durable at treating weight regain after RYGB.
中文翻译：
Roux-en-Y胃搭桥术后经口出口减少的五年治疗体重恢复的结果。
背景与目的经口出口减少（TORe）是Roux-en-Y胃旁路术（RYGB）合并胃空肠吻合术（GJA）后体重减轻的患者的常见内镜治疗方法。这项研究旨在评估TORe的长期疗效。方法这是一项回顾性研究，回顾性收集了因体重增加或体重减轻不足而接受TORe治疗的RYGB患者的数据。主要结果是TORe在1、3和5年时的疗效。次要结果是手术细节，安全性和TORe后长期体重减轻的预测指标。结果331名RYGB患者接受了342次TORe手术并符合入选标准。其中，分别有331名，258名和123名患者进行了1年，3年和5年的随访。平均体重指数为40±9 kg / m2。TORE之前的GJA大小为23。4±6.0毫米，在TORe之后降至8.4±1.6毫米。患者在1、3和5年时经历了8.5％±8.5％，6.9％±10.1％和8.8％±12.5％的总体重减轻（TWL），随访率分别为83.3％，81.8％和82.9％，分别。在342个TORe程序中，分别使用单荷包线，间断，双荷包线和连续缝线模式进行的缝合率分别为76％，17.5％，4.4％和2.1％，每个GJA平均要缝合9±4针。袋的加固缝合率为57.3％，平均每个袋缝3±2针。没有严重的不良事件。一些患者（39.3％）接受了额外的减肥治疗（药物治疗或手术），其中3.6％的患者再次接受TORE。1年时的减肥量（β= .43，P = .01）和其他内窥镜减肥方法（β= 8.52，P =。01）是5年TWL百分比的预测指标。结论TORY在治疗RYGB后的体重恢复方面似乎是安全，有效和持久的。
更新日期：2019-12-07
中文翻译：
Roux-en-Y胃搭桥术后经口出口减少的五年治疗体重恢复的结果。
背景与目的经口出口减少（TORe）是Roux-en-Y胃旁路术（RYGB）合并胃空肠吻合术（GJA）后体重减轻的患者的常见内镜治疗方法。这项研究旨在评估TORe的长期疗效。方法这是一项回顾性研究，回顾性收集了因体重增加或体重减轻不足而接受TORe治疗的RYGB患者的数据。主要结果是TORe在1、3和5年时的疗效。次要结果是手术细节，安全性和TORe后长期体重减轻的预测指标。结果331名RYGB患者接受了342次TORe手术并符合入选标准。其中，分别有331名，258名和123名患者进行了1年，3年和5年的随访。平均体重指数为40±9 kg / m2。TORE之前的GJA大小为23。4±6.0毫米，在TORe之后降至8.4±1.6毫米。患者在1、3和5年时经历了8.5％±8.5％，6.9％±10.1％和8.8％±12.5％的总体重减轻（TWL），随访率分别为83.3％，81.8％和82.9％，分别。在342个TORe程序中，分别使用单荷包线，间断，双荷包线和连续缝线模式进行的缝合率分别为76％，17.5％，4.4％和2.1％，每个GJA平均要缝合9±4针。袋的加固缝合率为57.3％，平均每个袋缝3±2针。没有严重的不良事件。一些患者（39.3％）接受了额外的减肥治疗（药物治疗或手术），其中3.6％的患者再次接受TORE。1年时的减肥量（β= .43，P = .01）和其他内窥镜减肥方法（β= 8.52，P =。01）是5年TWL百分比的预测指标。结论TORY在治疗RYGB后的体重恢复方面似乎是安全，有效和持久的。
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