Matteo Maria Valeria, Gallo Camilla, Pontecorvi Valerio, Bove Vincenzo, De Siena Martina, Carlino Giorgio, Costamagna Guido, Boškoski Ivo
Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy.
Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
J Pers Med. 2022 Oct 6;12(10):1664. doi: 10.3390/jpm12101664.
Obesity is a chronic, relapsing disease representing a global epidemic. To date, bariatric surgery is the most effective treatment for morbid obesity in the long-term. Roux-en-Y gastric bypass (RYGB) is one of the most performed bariatric interventions, with excellent long-term outcomes. However, about one-third of patients may experience weight regain over time, as well as dumping syndrome. Both these conditions are challenging to manage and require a multidisciplinary and personalized approach. The dilation of the gastro-jejunal anastomosis is a recognized etiological factor for both weight regain and dumping syndrome. Dietary modifications, behavioral interventions, and medications represent the first therapeutic step. Revisional surgery is the traditional approach when non-invasive treatments fail. However, re-interventions may be technically difficult and are associated with increased morbidity and mortality. Transoral outlet reduction (TORe) is an endoscopic procedure aimed at reducing the size of the anastomosis and is proposed as a minimally invasive treatment of weight regain and/or dumping syndrome refractory to conservative therapies. This review is aimed at providing a narrative overview of the role of TORe as part of the multidisciplinary therapeutic toolkit nowadays available to approach weight regain and dumping syndrome after RYGB.
肥胖是一种慢性复发性疾病，是全球性的流行病。迄今为止，减肥手术是长期治疗病态肥胖最有效的方法。 Roux-en-Y胃旁路术（RYGB）是实施最多的减肥手术之一，具有出色的长期效果。然而，随着时间的推移，约三分之一的患者可能会体重反弹，还会出现倾倒综合征。这两种情况都难以处理，需要多学科的个性化方法。胃空肠吻合口扩张是体重反弹和倾倒综合征公认的病因。饮食调整、行为干预和药物治疗是首要治疗步骤。当非侵入性治疗失败时，翻修手术是传统方法。然而，再次手术在技术上可能很困难，且会增加发病率和死亡率。经口缩窄术（TORe）是一种内镜手术，旨在缩小吻合口大小，被提议作为治疗对保守治疗无效的体重反弹和/或倾倒综合征的微创方法。本综述旨在对TORe作为多学科治疗工具的一部分在处理RYGB术后体重反弹和倾倒综合征方面的作用进行叙述性概述。
