# Enhanced transoral outlet reduction using endoscopic submucosal dissection and zipper-type suture technique after Roux-en-Y gastric bypass

## TL;DR

A new minimally invasive technique is introduced to reduce weight regain after gastric bypass surgery by modifying the stomach outlet.

## Contribution

A modified transoral outlet reduction technique combining submucosal dissection and a zipper-style suture is proposed.

## Key findings

- A patient achieved 14% total body weight loss after the modified procedure.
- GERD symptoms were resolved with no adverse events reported.
- The modified technique shows potential for improved durability and outcomes.

## Abstract

Weight regain after Roux-en-Y gastric bypass is common and often linked to anatomical changes such as gastrojejunal anastomosis (GJA) dilation and pouch enlargement. Transoral outlet reduction (TORe) offers a minimally invasive alternative to surgical revision. We present a modified TORe technique incorporating submucosal dissection, argon plasma coagulation, zipper-style GJA suturing, and distal pouch tubularization.

A 53-year-old woman with post-Roux-en-Y gastric bypass weight recurrence and GERD underwent enhanced TORe. The procedure included submucosal dissection of the GJA, argon plasma coagulation, zipper-pattern endoscopic suturing for GJA reduction, and tubularization of the distal gastric pouch.

At 6-month follow-up, the patient achieved 14% total body weight loss and resolution of GERD symptoms. No adverse events occurred.

This modified zipper-TORe approach is safe and efficient and may enhance durability and clinical outcomes.