The Best of ASGE Endoscopy from DDW (On-Demand) | June 2021-TORe Tips and Tricks for Maximizing Weight Loss

Video Transcription

Video Summary

The video discussed techniques to manage weight regain after bariatric surgery, specifically focusing on transoral gastrointestinal reduction (TOR). Dr. Sai Girapina, an expert in the field of endobariatrics, highlighted tips and tricks for maximizing weight loss with TOR. TOR is an endoscopic procedure that reduces the outlet size to treat weight regain after gastric bypass surgery. Research has shown a positive correlation between the size of the outlet and weight regain. The video discussed the timeline of TOR, including the first description by Chris Thompson in 2003 and subsequent studies that established its effectiveness. Different TOR procedures were also discussed, including placation TOR and suturing TOR. Pre-procedure tips included smoking cessation, ordering blood work, and conducting an upper GI series or endoscopy. The video also provided recommendations for choosing the appropriate TOR procedure based on patient anatomy. Tips and tricks for the procedure itself were discussed, including mucosal devitalization, outlet reduction using a purse-string suture pattern, cinching, and pouch reduction. The video emphasized the importance of suture management and avoiding complications such as suture crossing or excessive suture slack. The use of APC or ESD for mucosal devitalization was discussed, as well as the different outcomes associated with these techniques. The video concluded by discussing the success and longevity of TOR procedures, as well as post-procedure considerations such as avoiding excessive dilation of gastro-jejunostomy asthenosis.

Asset Subtitle

Pichamol Jirapinyo, MD, FASGE

Keywords

weight regain

TOR

endobariatrics

gastric bypass surgery

mucosal devitalization