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Transoral outlet reduction (TORe) is an incisionless, endoscopic procedure to address weight recurrence after Roux-en-Y gastric bypass. Given the chronic, progressive nature of obesity and the minimally invasive, anatomy preserving technique of TORe, the procedure is expected to be met with high patient acceptance and widening clinical adoption. Nevertheless, the approach to TORe has been heterogeneous. As endoscopic bariatric therapies are increasingly incorporated into the multidisciplinary management of obesity, it is crucial to have a standardized, evidence-based framework for their implementation. In this review, based on the available literature and the authors' combined experience of over 1,000 TORe procedures, we present our approach to patient selection, procedural technique, troubleshooting, and patient aftercare unique to TORe.
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http://dx.doi.org/10.14309/ajg.0000000000002821 | DOI Listing |
Updates Surg
August 2025
Department of Surgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.
This is the first report to present a novel application of TORe for anatomical revision in a patient with Prader-Willi syndrome and super-super obesity, following substantial weight regain after Scopinaro surgery performed 9 years prior. The procedure involved APC-induced mucosal ablation and endoscopic full-thickness suturing. Postoperatively, the patient achieved 34% excess weight loss and 25.
View Article and Find Full Text PDFGastrointest Endosc
July 2025
Center for Digestive Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Roux-en-Y gastric bypass is a bariatric surgery associated with durable long-term weight loss in most, but not all, patients. Transoral outlet reduction (TORe) is an endoscopic procedure that reduces the gastrojejunostomy diameter and gastric pouch volume to promote weight loss in patients with recurrent weight gain after Roux-en-Y gastric bypass. This systematic review and meta-analysis, conducted by the Association for Bariatric Endoscopy in collaboration with the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee, aimed to evaluate whether TORe meets the performance thresholds outlined in the ASGE preservation and incorporation of valuable endoscopic innovations (PIVI) document for the clinical adoption of endoscopic bariatric therapies.
View Article and Find Full Text PDFACG Case Rep J
July 2025
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Weight recurrence is a late complication after Roux-en-Y gastric bypass. The transoral outlet reduction (TORe) emerged as an endoscopic alternative to revisional surgery for weight recurrence due to a dilated and incompetent gastrojejunal anastomosis. The procedure has been documented as safe and effective in clinical trials and other high-quality medical literature.
View Article and Find Full Text PDFJ Clin Med
July 2025
Division of Gastroenterology and Hepatology, Mayo Clinic Hospital, Rochester, MN 55905, USA.
Obesity is a major global health challenge associated with significant metabolic and gastrointestinal comorbidities. While metabolic and bariatric surgery remains the gold standard for durable weight loss, the desire for additional options has fueled the development of endoscopic bariatric therapies (EBTs) as another tool for weight loss. This review examines established EBTs, including endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGBs), and transoral outlet reduction (TORe), alongside emerging therapies such as duodenal mucosal resurfacing (DMR), incisionless anastomosis creation, and fully automated endoscopic gastric remodeling systems.
View Article and Find Full Text PDFObes Surg
August 2025
Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
The latest bariatric endoscopic techniques include transoral outlet reduction (TOR) and bariatric endoscopic gastric remodeling (BEGR). Weight loss and comorbidity resolution outcomes from bariatric endoscopy remain inferior to those of bariatric surgery. Additionally, some patients are either ineligible for or prefer not to undergo surgery.
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