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A novel approach for weight regain after Roux-en-Y gastric bypass: Staged transoral outlet reduction (TORe) followed by surgical type 1 distalization
Roux en-Y gastric bypass (RYGB) is an effective modality for substantial long-term weight loss. Although patients experience 60% to 80% excess weight loss after RYGB, about one-third of these patients experience weight regain and relapse of obesity-related pathologies over time.1,2 This subset of patients presents a treatment challenge because lifestyle modifications and pharmacologic therapies may have limited efficacy.3Endoscopic sleeve gastroplasty is feasible after failed modified primary obesity surgery endoluminal procedure
Endoscopic sleeve gastroplasty (ESG) or gastric plication is a recent, minimally invasive treatment in bariatric endoscopy. The basic mechanisms of action are gastric volume reduction and alteration of gastric peristalsis.1 Currently, 3 devices are used in daily clinical practice: Apollo Overstitch (Apollo Endosurgery, Austin, Tex, USA), Endomina (Endo Tools Therapeutics, SA-ETT, Gosselies, Belgium), and an incisionless operating platform (USGI Medical, San Clemente, Calif, USA). They are used to perform the modified primary obesity surgery endoluminal (POSE-2) procedure.
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