Combining Transoral Outlet Reduction with Pharmacotherapy Yields Similar One-year Efficacy with Improved Safety Compared to Surgical Revision for Weight Regain Following Roux-en-Y Gastric Bypass.

BACKGROUND AND AIMS: Transoral outlet reduction (TORe) and anti-obesity medication (AOM) are effective treatments for weight regain following Roux-en-Y gastric bypass (RYGB). This study aims to 1) assess the efficacy of combination therapy (TORe + AOM) for treating weight regain and 2) compare the safety and efficacy of combination therapy to AOM alone, TORe alone and surgical revision of RYGB.

METHODS: This was a retrospective study of RYGB patients with weight regain who underwent combination therapy, defined as initiation of at least one AOM within 6 months prior to or after TORe. Outcomes included weight loss following combination therapy and comparison of combination therapy to AOM alone, TORe alone and surgical revision.

RESULTS: 145 RYGB patients underwent combination therapy. Most commonly prescribed AOMs included topiramate, phentermine/topiramate, phentermine and liraglutide. At 12 months, patients experienced 15.2±7.4% TWL. The proportion of patients who achieved ≥5% TWL at 12 months was 90%. Combination therapy was associated with greater weight loss than AOM alone (15.2±7.4% vs 6.8±8.2% TWL, p<0.0001) or TORe alone (15.2±7.4% vs 8.7±8.3% TWL, p<0.0001), with similar SAE rates (2.1% vs 4.7% vs 0.6% for combination therapy vs AOM alone vs TORe alone (p>0.05)). Combination therapy yielded similar weight loss to surgical revision (15.2±7.4% vs 16.4±13.1% TWL, p=0.34), with a lower SAE rate (2.1% vs 14.3%, p=0.0004).

CONCLUSION: Combination of TORe with AOM is superior to either therapy alone providing similar efficacy to surgical revision with a better safety profile for the treatment of weight regain following RYGB.