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Gastrointest Endosc. 2014 Jun;79(6):984-9. doi: 10.1016/j.gie.2014.02.006. Epub 2014 Apr 12.

Comparison of a superficial suturing device with a full-thickness suturing device for transoral outlet reduction (with videos).

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  • 1Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

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.

DESIGN:

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

SETTING:

Tertiary-care center.

PATIENTS:

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.

INTERVENTION:

Transoral outlet reduction.

MAIN OUTCOME MEASUREMENTS:

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).

LIMITATIONS:

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

CONCLUSION:

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.

Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

PMID:
24721521
[PubMed - indexed for MEDLINE]
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