Use of transoral outlet reduction endoscopy (TORE) in the management of resistant dumping syndrome

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INTRODUCTION: Dumping Syndrome (DS) and Reactive Hypoglycaemia (RH) are common occurrences post bariatric surgery, particularly post Roux-En-Y Gastric Bypass (RYGB). We present our initial results using Transoral Outlet Reduction Endoscopy (TORE) in the management of patients who failed to respond to dietary and medical treatment for DS. METHODS: All patients identified to have symptoms consisting with DS were discussed in the complex bariatric MDT and assessed for suitability of TORE via an upper gastro-intestinal endoscopy to assess the length of the pouch, size of the gastro-jejunostomy and the presence of alternative pathologies. RESULTS: Since the onset of our TORE services in January 2025, we identified 17 patients for treatment with TORE. The median age was 45yrs (IQR 36-55). Sixteen patients (94%) were women and all patients scored ≥ 7 on the Sigstad scoring questionnaire. Two patients had previously undergone conversion of gastric sleeve to a RYGB whilst all others had a primary RYGB. 2 patients were found to have unfavourable anatomy and was not safe to proceed with the procedure whilst one patient was followed up privately hence no data were available for review. The data showed a complete response to treatment at 2 years for 66% of patients. Four patients did not respond to treatment with TORE and are being considered for surgical intervention. CONCLUSIONS: TORE is an effective treatment for patients with DS not responsive to medical and dietary therapy. We believe it is an effective non-surgical treatment method prior to considering reversal of the original surgery (RYGB) with its associated weight regain. Further work is planned to assess its outcomes in larger groups of patients.

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