Endobariatric revision procedure

Introducing Transoral Outlet Reduction (TORe)

transoral-outlet-reduction-tore

An estimated 15,000 endoscopic revisions of bariatric procedures performed worldwide.1

More than 150 clinical papers and abstracts have been published on TORe.2


TORe is an endoscopic procedure that provides a safe and clinically effective alternative to surgical revision of a Roux-en-Y gastric bypass. In combination with gastric pouch reduction, TORe can address anastomic dilation and induce weight loss.

No incisions or scars

A day case procedure for many patients

Low adverse event rate3

How the TORe procedure is performed

A trained gastroenterologist or surgeon who performs bariatric procedures uses the OverStitch™ system to reduce the size of the dilated gastrojejunal outlet back to the original intended size. In some cases, a gastric pouch reduction can also be performed at the same time.

Anatomic modifications result in earlier satiety and weight loss. TORe is performed under general anaesthetic and, for most people, can be a day case procedure.

Sutures are placed in an interrupted, running, or circumferential (purse-string) pattern to reduce the size of the outlet.

Additional suturing can be performed to reduce the size of the gastric pouch, if required.

Clinical evidence

6%

Large meta-analysis showed an average of 6% total body weight loss (TBWL) at 12 months.4

9-12%

Latest studies using the purse-string approach report 9-12% TBWL at 12 months.5,6

5&7 y.

Long-term studies support durable weight loss at 5 and 7 years.5,7

A comparative study demonstrated a lower rate of adverse events with TORe compared to surgical revisions, whilst achieving similar outcomes in long-term efficacy.3
 

  TORe n=31LAP n=31p-value
Effectiveness at 5 years11.5% TBWL13.1% TBWL0.67
Adverse events6.5%29.0%0.04
Safety profile0% SAE* rate19.4% SAE rate0.024

Dolan, et al; Gastrointestinal Endoscopy. 2021

  • Matched cohort population
  • Multicentric
  • Long follow-up studies: 5yrs
*Values are n (%). Adverse event rate comparison between endoscopic and surgical gastrojejunal anastomosis revision. Serious adverse events were determined in reference to the American Society for Gastrointestinal Endoscopy lexicon for reporting endoscopic adverse events and the National Surgical Quality Improvement Program. Early events defined as those occurring within 30 days of revision.

TORe Patient Stories: Alessia’s Story

Listen to Alessia’s story as she shares her TORe journey.

TORe for Patients

Key Resource

TORe Brochure

Re-envision bariatric revisions

Filename
TORe-Brochure.pdf
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application/pdf
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References

  1. Estimates based on Apollo Endosurgery internal sales data, 2019
  2. Data on file.
  3. Dolan, et al; Endoscopic versus surgical gastrojejunal revision for weight gain in Roux-en-Y gastric bypass patients: 5-year safety and efficacy comparison. Gastrointestinal Endoscopy. 2021.
  4. Jaruvongvanich V, et al. Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis. Gastrointestinal Endoscopy. 2020.
  5. Jirapinyo P, et al. Five-year outcomes of Transoral Outlet Reduction for the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointestinal Endoscopy. 2020.
  6. Meyers, et al. Factors associated with weight loss after endoscopic Transoral Outlet Reduction (TORe). Gastrointestinal Endoscopy. Volume 95, No. 6S. 2022.
  7. Jirapinyo, et al. Seven-year Outcomes of Transoral Outlet Reduction for the Treatment of Weight Regain After Roux-en-Y Gastric Bypass. Gastrointestinal Endoscopy. 2020. Subset of patients included in study are also represented in 5-year data
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