S2304 Long-Term Outcomes of Transoral Outlet Reduction for Weight Regain After Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis

Introduction: Roux-en-Y gastric bypass (RYGB) is a well-established bariatric procedure; however, weight regain remains a significant concern, affecting up to 30% of patients. Transoral outlet reduction (TORe) is an endoscopic intervention that reduces the size of the gastrojejunal anastomosis (GJA) to address post-RYGB weight regain. We conducted a systematic review and meta-analysis to evaluate long term effectiveness of TORe in this population. Methods: A comprehensive search of 6 databases (Pubmed, Embase, Scopus, Web of Science, CINAHL and Cochrane Library) was performed until 2024. Studies reporting ≥12 months of follow-up after TORe for weight regain post-RYGB were included. Primary outcomes were the percentage of excess weight loss (%EWL). Secondary outcomes included reduction in GJA diameter and serious adverse events requiring surgery. A random-effects model was used to pool estimates. Heterogeneity was assessed using the I² statistic. Results: Nine studies including 1,167 post-RYGB patients were analyzed. Most were woman, aged 40–52. Serious adverse events requiring surgery were rare (1–3 patients/study). Pooled mean %EWL was 24.28% (95% CI: 19.55–29.01; P < 0.05) at 12 months, 19.65% (95% CI: 7.87–31.43; P < 0.05) at 24 months, and 10.74% (95% CI: −1.47 to 22.94; P = 0.08) at 36 months. TORe significantly reduced GJA diameter by 17.11 mm (95% CI: 13.37–20.85; P < 0.05). Study identification and selection process is summarized in the PRISMA diagram. Conclusion: TORe is a safe and effective endoscopic treatment for weight regain following RYGB, demonstrating durable outcomes with significant weight loss through 12 and 24 months. Although weight loss at 36 months showed a positive trend, it did not reach statistical significance, highlighting the need for further long-term studies. TORe is associated with a low rate of serious adverse events. This meta-analysis is unique as it evaluates long-term outcomes beyond one year, reinforcing the sustained benefit of TORe as a minimally invasive alternative to surgical revision. These findings support its role in the long-term management of post-bypass weight regain.