Gastric bypass is one of the most common bariatric surgeries in which a large portion of the stomach and the first part of the small bowel is diverted, creating a small stomach pouch attached directly to the small intestine. Both the pouch and the connection site to the small bowel, called the ‘outlet,’ can enlarge over time allowing patients to eat more before feeling full. Unfortunately, many patients will eventually regain weight after the surgery.
With endoscopic gastric bypass revision, we tighten this outlet and the stomach pouch (if needed) by placing sutures in a minimally invasive way. Compared to surgery, this is an incisionless approach that will allow you to return to that sense of fullness and to lose the weight you previously lost with minimal risk.
The TORe procedure is a minimally invasive, incisionless and same-day outpatient endoscopic weight loss procedure performed to reduce the size of the outlet and in some cases the stomach pouch as well. This procedure allows you to feel full sooner and lose weight, returning you to your original post-gastric bypass surgery state. It is also highly effective in maintaining the weight loss as this is a permanent revision in reducing the outlet size.
The procedure is a minimally invasive, and incisionless endoscopic procedure that usually takes less than 30 minutes. While you are sedated, your physician will insert an endoscope, a small camera attached to a thin and flexible tube, through your mouth and into your stomach. A suturing device is connected to the tube, enabling stitches to be placed around the outlet, and in some cases the stomach pouch itself. When these sutures are placed and pulled, the size of the outlet and gastric pouch will reduce. This procedure will allow you to restore the feeling of fullness, eat less, and ultimately lose weight again.
To be a candidate, you must be of at least 21 years of age (as authorized by the FDA) with a body mass index (BMI) of at least 30 (calculate your BMI here). You must be at least two years from your gastric bypass surgery and have regained the weight lost following your original gastric bypass surgery. You will have a consultation with the doctor to review your medical history to determine if you are a candidate for TORe prior to scheduling the procedure. We encourage you to ask questions you may have regarding the procedure during this office visit. TORe is a great option for those who want to avoid surgical revision or for those who are not candidates for surgical revision. Results are further optimized if you are motivated to committing to an ongoing healthy lifestyle, which includes dietary modifications and exercise.
Estimated weight loss from bariatric bypass revision procedure is about 10-15% of total body weight. These results are optimized by following a low fat diet and including adequate exercise as part of a healthy lifestyle. Other health benefits, in addition to weight loss, include improvement in high blood pressure, type 2 diabetes, high cholesterol, fatty liver, and obstructive sleep apnea. Importantly, this is a permanent and non-surgical approach in restoring the original size of the stomach pouch and outlet.
Most patients will experience mild symptoms immediately after and for a few days following the procedure including such as abdominal discomfort and nausea. These symptoms will usually disappear after your body becomes accustomed to your reduced stomach and/or outlet size again. We will prescribe medications for use before and after your procedure to help manage these symptoms. Compared to surgery, the possibility of complications are drastically reduced. Serious symptoms requiring medical attention will be thoroughly discussed at your consultation visit and prior to your procedure.
We also offer a 24/7 concierge aftercare service for our patients. The aftercare program offers multiple benefits such as individualized meal planning and shopping lists, unlimited text messaging support (including on evenings and weekends), therapy and optional counseling with loved ones. We will help you through your recovery while giving you tools to help you stay on track and peace of mind that you are being cared for.
Yes, now that your stomach has again decreased in size and the outlet to the small intestine is smaller, you will not be able to eat the same quantity of food that you were able to prior to your procedure. You will be given a booklet with dietary recommendations regarding what you should and should not eat in the days to weeks after the procedure while your outlet and possibly gastric pouch accommodates to its new size.
In addition to dietary modifications, we will also assist you in exercise planning with trained experts who will work with you individually to track your progress. These lifestyle changes are meant to be lifelong to help you maintain weight loss.
As with any procedure, there are risks for potential complications. However, compared to surgical revision, the risks of any major complication (bleeding, infection, organ injury) are significantly less (<1%) since there are no external incisions.
Endoscopic gastric bypass revision is a complex endoscopic procedure that should be performed by highly skilled gastroenterologists. We at 4ward Wellness are advanced endoscopists who have completed additional training in complex and high risk endoscopic procedures. We possess the skills and tools to not only perform these procedures but also manage the unlikely risk of potential complications associated with any endoscopic procedure. We are proud to offer an individualized approach in achieving your weight loss goals. We are here to listen and work with you as you choose the next step in your weight loss journey and achieve a healthier lifestyle.
The gastric endoscopic sleeve revision procedure costs $9,999. This cost not only covers the procedure but also your journey to wellness consisting of post procedure follow-up appointments and lifestyle coaching/support available to you for up to one year. These procedures are not currently covered by all insurance companies. We understand financial limitations can be a barrier to undergoing elective treatments to improve your health. We have finance options available including CareCredit to help you move 4ward in your wellness journey.
*These costs do not reflect any lab work and/or fees as outlined in your consultation.
We at 4ward Wellness welcome patients from anywhere, and we know it is crucial to have the right accommodation when visiting us. Located 20 minutes from Albany International Airport, 4ward Wellness is looking forward, in the future, to partnering with nearby hotels. For now, we encourage you to choose from the many accommodations in the greater Albany area. Our friendly staff can help you find accommodation that is suitable for your needs. Let us know how we can help.
Remember, this is not just a one-time visit, but is a long-term journey. You will return the next day to receive IV fluids at our infusion center. We will check in during this visit to assess your recovery. You will also have scheduled follow ups in the office soon after your procedure and then once every couple months for up to a year.
During the 1 year following your procedure, you will have weekly follow-ups with our bariatric counselor and nutritionist. This will also include weekend and after hour access to our specialists with any questions or concerns to help you through your recovery and give you peace of mind that you are being cared for.
