First transoral outlet reduction endoscopy procedure performed at Ohio State

Transoral outlet reduction endoscopy (TORe) is a minimally invasive procedure to help patients manage weight regain, often after undergoing gastric bypass surgery, especially in patients who snack on high-calorie foods and do not exercise. TORe is novel as it is nonsurgical and incisionless and aims to reduce the size of the opening between the stomach pouch and the small intestine to slow stomach emptying and help patients feel fuller longer.

The bariatric endoscopy unit, which is integrated into Ohio State’s bariatric program, was developed by Hamza Shah, DO, clinical assistant professor of Internal Medicine at The Ohio State University College of Medicine. Dr. Shah recently completed the first TORe procedure at The Ohio State University Wexner Medical Center for a patient who wasn’t a surgical candidate for gastric bypass surgery He says she was relieved to avoid the longer recovery phase that comes with other procedures.

“She was back to her usual routine and activities by the end of the week,” Dr. Shah says.

Dr. Shah says the procedure reduces the size of the gastric outlet by applying sutures in a certain pattern.

“The diameter is significantly reduced, re-establishing the patient’s ability to have restriction in how much they eat,” Dr. Shah says. “If the gastric pouch is also found to be enlarged, this is also reduced in size to further enhance the restriction and allow weight loss.” 

Raj Shah, MD, co-leader of the bariatric and metabolic endoscopy program, joined the department last year. His evidence-based, up-to-date interventions are based on his new research and are helping further develop the endobariatric program. Together, Drs. Shah are currently evaluating and accepting patients for TOR-e, in addition to endoscopic sleeve gastroplasty and gastric balloon placement.

These endobariatric procedures for patients who have not had prior surgeries for weight loss or have experienced weight regain after surgery offer a new standard of care that will increase individualized treatment approaches. 

“The goal is to delay gastric pouch emptying and increase the sensation of satiety,” Dr. Hamza Shah says. “This procedure has a high safety profile when compared to revisional bariatric surgery and will help patients maintain weight loss.”

Giving people more treatments that help them lose weight has the potential to improve overall health and transform the health of our communities.