LAUSR

BACKGROUND AND AIMS Gastric Plication involves inverting the stomach with tissue anchor placement to achieve serosa to serosa apposition. One potential application of gastric plication is the treatment of weight regain following Roux-en-Y gastric bypass (RYGB), a procedure also known as plication transoral outlet reduction (P-TORe). This study aims to assess technical feasibility, safety and efficacy of P-TORe. METHODS This was a registry study of RYGB patients who underwent P-TORe for weight regain. The primary outcome was the amount of weight loss and clinical success rate, defined as percent total weight loss (%TWL) of at least 5%, at 12 months. Secondary outcomes included technical success, adverse events (AEs) and predictors of weight loss. RESULTS 111 RYGB patients underwent P-TORe. Average BMI was 38.5±7.5 kg/m2. Baseline GJA and pouch sizes were 17±6 mm and 5±2 cm, respectively. PRIMARY OUTCOME At 12 months, patients experienced 9.5±8.5% TWL. Clinical success rate was 73%. SECONDARY OUTCOMES Technical success rate was 100%. Argon plasma coagulation (APC) was performed around the GJA in all patients (100%) prior to plication placement. The total number of plications per case was 7±3. Overall AE rate was 12.6%. These included GJA stenosis (9.9%), melena due to marginal ulceration (1.8%) and deep vein thrombosis (0.9%). The severe AE rate was 0%. Predictors of weight loss were the amount of weight regain and baseline pouch length. CONCLUSION This novel P-TORe technique combining APC with gastric plication appears technically feasible, safe and effective at treating weight regain following RYGB.