Abstract
BACKGROUND AND AIMS: Weight regain after Roux-en-Y gastric bypass is common and often linked to anatomical changes such as gastrojejunal anastomosis (GJA) dilation and pouch enlargement. Transoral outlet reduction (TORe) offers a minimally invasive alternative to surgical revision. We present a modified TORe technique incorporating submucosal dissection, argon plasma coagulation, zipper-style GJA suturing, and distal pouch tubularization. METHODS: A 53-year-old woman with post-Roux-en-Y gastric bypass weight recurrence and GERD underwent enhanced TORe. The procedure included submucosal dissection of the GJA, argon plasma coagulation, zipper-pattern endoscopic suturing for GJA reduction, and tubularization of the distal gastric pouch. RESULTS: At 6-month follow-up, the patient achieved 14% total body weight loss and resolution of GERD symptoms. No adverse events occurred. CONCLUSIONS: This modified zipper-TORe approach is safe and efficient and may enhance durability and clinical outcomes.