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.


METHODS
Matched cohort study: patients were matched sequentially by GJ anastomosis aperture, body mass index, and age.


METHODS
Tertiary-care center.


METHODS
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.


METHODS
Transoral outlet reduction.


METHODS
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).


CONCLUSIONS
This was a single-center, retrospective, cohort study.


CONCLUSIONS
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.
Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts.
Nitin
N
Kumar
Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts.
Christopher C
CC
Thompson
D015992:Body Mass Index; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome