Service Description

TORe – Transoral Outlet Reduction A Minimally Invasive Endoscopic Revision After Gastric Bypass What Is TORe? Transoral Outlet Reduction (TORe) is a non-surgical, incisionless endoscopic procedure used to treat weight regain or dumping syndrome in patients who previously underwent a Roux-en-Y Gastric Bypass (RYGB). Over time, the gastric pouch or the gastrojejunal (GJ) anastomosis may enlarge, reducing satiety and allowing increased caloric intake. TORe addresses this by reducing the outlet size to restore restriction. How Does TORe Work? - Performed via endoscopy through the mouth. - A special suturing device (OverStitch or similar) is used to place circumferential full-thickness sutures around the gastrojejunal anastomosis. - In some techniques, argon plasma coagulation (APC) may be applied to ablate mucosa and improve suture hold. - The goal is to shrink the outlet diameter, restoring slower gastric emptying and early satiety. - Procedure time: ~30–60 minutes - Recovery: Outpatient, minimal downtime ✅ Benefits of TORe - Non-surgical: No incisions or external scars - Treats weight regain: Helps patients lose regained pounds - Addresses dumping syndrome: By slowing food transit into the small intestine - Low risk profile: Very low complication rates (<1%) - Repeatable: Can be performed again if needed Indications for TORe - Weight regain after RYGB (typically >10–15% of regained weight) - Enlarged gastrojejunal stoma (>20 mm diameter) - Persistent or new-onset dumping syndrome - Loss of satiety, increased hunger, poor portion control Note: Best outcomes are seen in patients with proper lifestyle and nutritional follow-up. ⚠️ Risks and Considerations - Nausea, pain, or bloating: Usually mild and temporary - Bleeding or perforation: Rare (<1%) - Multiple sessions: In some cases, repeat TORe may be needed - Requires follow-up: TORe is a tool, not a stand-alone solution 📈 Outcomes - 8–10% total body weight loss (TBWL) at 12 months - Reduction of GJ anastomosis from ~24 mm to ~8–10 mm - Improved satiety and portion control - High resolution rates for dumping syndrome (>80%) TORe is especially effective when combined with nutrition counseling and behavioral support. TORe vs Surgical Revision Invasiveness - Non-surgical - Major abdominal surgery Risk - Low - Higher (leaks, strictures) Downtime - 1–3 days - 2–3 weeks Durability - Moderate (may need repeat) - Long-lasting Flexibility - Repeatable - Irrevers