S2277 Transoral Outlet Reduction Using a New Zipper Technique vs the Purse-string Technique for Weight Regain Following RYGB

Introduction: Transoral outlet reduction (TORe) is a proven safe and effective treatment for weight regain following Roux-en-Y gastric bypass (RYGB); however, there is room for improvement in the current technique. Purse-string suturing has been the standard practice for the last decade. Here, we compare a new modified technique (zipper) with the purse-string technique in a cohort of patients who have experienced weight regain following RYGB. Methods: We retrospectively analyzed a prospectively constructed database of patients referred to the endobariatric clinic of a tertiary care referral center for weight regain after RYGB from 2021 to 2024. Patients who underwent TORe using the zipper technique (Z-TORe) were matched to a cohort of patients who underwent purse-string TORe (PS-TORe) based on age, gender, and baseline body mass index (BMI). The primary outcome was comparing the need for repeat intervention. Secondary outcomes included total body weight loss (TBWL), excess weight loss (EWL), periprocedural complications, and procedure duration. Outcomes were compared using an unpaired t-test, Kaplan-Meier curve, and KM curve truncated to 300 day and projections at 5 years. Results: A total of 32 patients who underwent TORe were included (9 had Z-TORe and 23 had PS-TORe). The mean age was 55 ± 10 years, and 85% were woman. Mean TBWL% at 3 and 6 months was 7.9% ± 3.6% and 11.5 ± 5.3 in Z-TORe, compared to 8.3 ± 4.7% and 9 ± 7.4% in the PS-TORe, respectively (P = 0.82, 0.33). EWL% at 3 and 6 months was 17.4 ± 7.9% and 21.8 ± 16.6% with zipper and 19.8 ± 13.2% and 23.7 ± 17% with purse-string, respectively (P = 0.32, 0.40). More patients in the PS group required repeated procedures for weight regain compared to the Z-TORe group 7 (30%) vs 0 (0%), P = 0.09, respectively. Early postprocedural complications occurred in no Z-TORe and 2 PS-TORe patients (outlet stricture), both requiring endoscopic reintervention. At 300 days, 77.6% of the PS-TORe group remained free from reintervention, compared to 100% of the Z-TORe group (P = 0.37), which projected trends to significance at 600 days (P = 0.11) and 5 years (P = 0.06) if the zipper group remains free of reintervention. Conclusion: While Zipper TORe achieved similar weight loss and comparable safety to the standard purse-string method, the need for repeat intervention was lower using this modified technique, with a projected improved durability. Long-term studies are necessary to confirm our findings.