Efficacy and Safety of Transoral Outlet Reduction for Dumping Syndrome After Roux-En-Y Gastric Bypass: A Systematic Review and Meta-Analysis

Introduction: Dumping syndrome is one of the major limitations of the long-term success of the Roux-En-Y Gastric Bypass (RYGB) and is associated with significant morbidity. It constitutes a complex of GI and vasomotor symptoms caused by rapid emptying of the hyperosmolar gastric contents into the small intestine resulting in the fluid shift into the intestinal lumen. Transoral outlet reduction through devitalization and endoscopic suturing of the gastro-jejunal anastomosis is an effective technique for dumping syndrome after RYGB. Recent studies have described the feasibility and safety of TORe for dumping syndrome. Our study aimed to perform a systematic review and meta-analysis to review the effectiveness and safety of TORe for severe symptoms of dumping syndrome. Methods: We developed individualized search strategies for databases such as MEDLINE, Embase, Web of Science, and Cochrane Central registry from the inception to May 2023. The primary outcomes of our interest were the technical and clinical success rates and the change in Sigstad’s score after the TORe procedure for severe symptoms of dumping syndrome. The secondary outcomes were the adverse events of the procedure. Technical success was defined as a successful dilation of the gastro-jejunal anastomosis, while clinical success was defined as Sigstad’s score < 7 six months after the procedure. We calculated pooled proportions with estimated rates using the random effect model for our primary outcomes. We also calculated the pooled mean Sigstad’s score after the procedure. I2 statistic was used to assess the heterogeneity. Publication bias was not assessed because the number of studies was less than 5 (Figure 1). Results: A total of 4 studies with 241 patients were included. The mean age of the patients was 45 ± 11. Pooled Technical and clinical success rates were 100% (CI: 99.08%, 100%) and 85.64% (CI: 59.11%, 99.85%), respectively. TORe was associated with a significant improvement in the dumping syndrome. The pooled mean Sigstad’s score calculated at 6-month after the procedure was 2.21 (CI: 1.02, 2.39, P < 0.01). The overall periprocedural adverse rate of TORe was 6.52% (CI: 0.12%, 18.72%). Conclusion: Our study concludes that TORe is an effective and safe procedure for dumping syndrome among RYGB patients. It has a high technical and clinical success rate with few adverse events. Future studies are required to compare this modality with the standard treatment procedures.Figure 1.: Pooled mean Sigstad's score 6 months after TORe.