Transoral Outlet Reduction for Dumping Syndrome After Roux-En-Y Gastric Bypass: a Comprehensive Systematic Review and Meta-Analysis

Abstract

Introduction: Dumping syndrome is a complication of Roux-en-Y gastric bypass (RYGB) surgery that can significantly affect quality of life. Transoral outlet reduction (TORe) is a minimally invasive endoscopic procedure that reduces the size of the gastrojejunal anastomosis (GJA) through ablation and/or endoscopic suturing, primarily used to address weight regain after RYGB. Emerging evidence highlights the feasibility and safety of TORe as a treatment for medically refractory dumping syndrome. This meta-analysis aims to evaluate the efficacy and safety of TORe for dumping syndrome. Methods: A systematic search of PubMed, Embase, and Web of Science was conducted through December 2024. Primary outcomes included clinical success (defined as sustained symptom improvement without requiring repeat TORe or revisional surgery at last follow-up) and the mean difference in pre- and post-procedural Sigstad's score assessments. Secondary outcomes included rates of post-TORe surgery, repeat TORe, and serious adverse events. Pooled rate estimates and mean differences (MD) with the corresponding 95% confidence intervals (CI) were calculated using random-effects models. Results: Six studies with 333 post-RYGB patients with dumping syndrome were included. The pooled clinical success of TORe was 83% (95% CI 71%-90%, I2 = 74%). Furthermore, TORe resulted in a significant improvement in Sigstad's score (MD - 11.12 [95% CI -15.33 to - 6.91], P < 0.001, I2 = 89%). The rate of serious adverse events was 3% (95% CI 0.7%-12.4%, I2 = 68%). Conclusions: Our findings suggest that TORe is a safe and effective minimally invasive treatment for patients with medically refractory dumping syndrome. Further prospective studies with longer follow-up durations are warranted to validate these findings.