Victoria Gomez, M.D., assistant professor of medicine, Gastroenterology and Hepatology, Mayo Clinic in Florida: Hi, my name is Victoria Gomez. I'm assistant professor of medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Florida. I also have a significant interest in bariatric medicine and endoscopic therapies.
Obesity, defined as a BMI greater than or equal to 30, is associated with significant medical issues. Bariatric surgery helps people lose significant weight. However, weight regain and recurrence of medical issues associated with the weight gain are issues that we are now seeing with increasing frequency in our patient population. A majority of these patients who undergo Roux-en-Y gastric bypass may regain 30% of the lost weight and a smaller fraction of people may even regain more weight.
Several factors affect this weight regain, including dietary and lifestyle habits. However, another interesting and important factor is the size of the opening that was created between the stomach and the small intestine during the Roux-en-Y gastric bypass operation. This opening is known as the gastrojejunal anastomosis. In several studies in the United States, it was found that dilation of this opening over time did lead to weight regain, and in fact, was shown to be a predictor of weight regained after Roux-en-Y gastric bypass surgery. Furthermore, in other patients, dilation of this opening can also cause loss of feeling of satiety with eating or even cause issues related to dumping syndrome.
Fortunately, options are available for revisioning of this opening. One option is surgery, however this requires a reoperation and can be technically challenging due to several factors. A less invasive and effective procedure that reduces the size of this opening is called the transoral outlet reduction, or TORe. This involves performing an upper endoscopy down the esophagus and into the stomach. And the outlet or the opening is reduced with the placement of full thickness sutures that are placed from the inside of the lining of the intestine as opposed to surgery in which sutures are placed from the outside of the lining of the intestine. At the completion of the procedure, a small opening connecting the gastric pouch in the intestine is left.
Studies have demonstrated that the transoral outlet reduction procedure is safe, effective, and with durable effects in patients with weight regain after gastric bypass surgery. Furthermore, this procedure has been shown to be effective at enhancing weight loss and slowing down the progression of weight regain over several years.
Evaluation for the transoral outlet reduction procedure, just like any other weight loss therapy, involves working with your multidisciplinary team of bariatric physicians, internists, dietitians, and even psychologists.
Achieving and sustaining weight loss with this procedure can only be accomplished with behavior modification through the support of your team members.
Our Mayo Clinic Bariatric Center, and Department of Gastroenterology are here for you and ready to help you take that next step toward a healthier lifestyle and reach successful weight loss.