Weight regain and dumping syndrome are known to be associated with widening of the gastro-jejunal anastomosis after Roux-en-Y gastric bypass. In this study, we aim to evaluate the efficacy of endoscopic outlet reduction in achieving weight loss and in alleviating symptoms of dumping syndrome

We conducted a retrospective analysis of a total of 45 cases of TORe after prior Roux-en-Y gastric bypass surgery.

Between May 2018 and July 2025, we performed TORe in 45 patients (8 male, 37 female; average age 48 years) at the endoscopy unit of the University Hospital in Augsburg.

All patients had previously undergone laparoscopic Roux-en-Y gastric bypass surgery before the TORe procedure. In 17 cases, a laparoscopic sleeve gastrectomy had been performed prior to the gastric bypass.

Endoscopic outlet reduction was performed using the Boston Scientific OverStitch NXT™ in 37 cases and the ovesco BARS system in 8 cases.

The primary endpoint of the study was the degree of weight loss after TORe, quantified as percentage total body weight loss (%TBWL). The secondary endpoint was the improvement in dumping symptoms, quantified by the reduction in the Sigstad score.

In 21 patients, TORe was performed for weight regain after bariatric surgery. In 12 cases, endoscopic outlet reduction was carried out due to postoperative dumping syndrome and in 17 cases, both weight regain and dumping syndrome were present.

Prior to TORe the average BMI was 37,7 kg/m2 and the average Sigstad’s score was 13,5.

Two patients were lost to follow-up and were therefore excluded from the statistical analysis. 

A statistically significant reduction in BMI was demonstrated at the first follow-up at 3–6 months (mean BMI 37,69 kg/m2; 35,29 kg/m2, p<0,005). A significant reduction in BMI was also observed at the second follow-up at 12-months (mean BMI 37,69 kg/m2; 33,97kg/m2, p<0,005). The %TBWL was 6,8% within 6 months and 6,7% at 12 months.

In addition, a significant decrease in the Sigstad’s score was observed at the initial follow-up within the first six months (mean 13,2; 7,8, p<0,05) as well as at the 12-month follow-up (mean 13,2; 6,1; p<0,005).

In 38% (18 cases), re-interventions were performed due to recurrent symptom exacerbation or weight regain. In 6 cases, argon plasma coagulation (APC) was used to reduce the outlet. In 10 cases, the anastomosis was re-tightened using the OverStitch NXT™. In 2 cases, the anastomosis was reduced using the ovesco BARS system.

In cases where APC therapy was used, multiple treatment sessions (min. 2, max.6 sessions) were performed at intervals of 6–8 weeks to achieve outlet reduction.

Endoscopic outlet reduction is an effective intervention for achieving both a reduction of dumping syndrome and clinically relevant weight loss in patients after Roux-en-Y gastric bypass surgery.