ENDOSCOPIC OUTLET REDUCTION
OVERSTITCH PROCEDURE
WHAT IS AN ENDOSCOPIC OUTLET REDUCTION?
Endoscopic Outlet Reduction or TORe (Transoral Outlet Reduction) is an endoscopic (gastroscopy) procedure using the Overstitch suturing system. It is used to place sutures (stitches) on the opening between the stomach and the small bowel (gastric outlet). It is sometimes referred to as the ‘Overstitch’, because it is performed using the Apollo OverStitch Device.
An Endoscopic Outlet Reduction may be beneficial for some gastric bypass patients (both OAGB and RYGB) with weight regain over time. It may also be used for previous one-anastomosis gastric bypass patients who suffer from bile reflux, instead of progressing with a revision operation.
After gastric bypass surgery, the gastric outlet (opening between the stomach pouch and the intestine) may gradually expand with time, increasing the capacity to hold food.
The Endoscopic Outlet Reduction procedure is used to reduce the size of the outlet as well as the stomach pouch to provide restriction for patients following gastric bypass.
The procedure is performed under a general anaesthetic and the OverStitch system is inserted by your surgeon through an endoscopy to place stitches at the opening between the stomach pouch and intestine to reduce the size of the outlet. Additional stitches may be placed on the wall of the pouch and when tightened reduces the size of the pouch.
The Endoscopic Outlet Reduction accomplishes outlet revision of a gastric bypass without the need for any incisions or operations. The entire procedure may take around an hour, and postoperative pain is usually minimal.
How is it performed?
The procedure is performed under a general anaesthetic and the OverStitch system is inserted by your surgeon through an endoscopy to place stitches at the opening between the stomach pouch and intestine to reduce the size of the outlet. Additional stitches may be placed on the wall of the pouch and when tightened reduces the size of the pouch.
The Endoscopic Outlet Reduction accomplishes outlet revision of a gastric bypass without the need for any incisions or operations. The entire procedure may take around an hour, and postoperative pain is usually minimal.
WHO IS ELIGIBLE FOR ENDOSCOPIC OUTLET REDUCTION?
Endoscopic Outlet Reduction is beneficial for patients who have had previous gastric bypass surgery and are experiencing weight gain or bile reflux.
How much weight can I expect to lose?
There have been several studies looking at weight loss outcomes following the Endoscopic Outlet Reduction procedure.
It is very difficult to predict how patients will respond to the Endoscopic Outlet Reduction, however in a large multi-centre trial [1], the proportion of patients achieving ≥5% total body weight loss at 12 months was 67.6%.
Overall, over 75% of patients experienced weight gain arrest or stabilisation at 6 and 12 months.
Are there any risks or side effects?
The risks are low, however complications include nausea and abdominal pain, with rare risks including bleeding and perforation.
Your surgeon will discuss all risks and possible side effects with you.
References
[1] Vargas, E.J., Bazerbachi, F., Rizk, M. et al. Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc 32, 252–259 (2018). https://doi.org/10.1007/s00464-017-5671-1
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Diagram
An illustration of what an Endoscopic Outlet Reduction would look like.
Video
Hear more from Dr Balalis about Endoscopic Outlet Reduction.
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