TORE (Transoral Outlet Reduction Endoscopy)

What is TORE?

Transoral Outlet Reduction Endoscopy (TORE) is a minimally invasive, non-surgical procedure used to treat weight regain in patients who have previously undergone Roux-en-Y gastric bypass (RYGB) surgery. Over time, the small opening (called the gastrojejunal anastomosis) between the stomach pouch and the small intestine can enlarge, reducing the feeling of fullness and allowing patients to eat more—often leading to weight regain.

TORE is designed to tighten or reduce the size of this outlet using an endoscopic suturing device, which is inserted through the mouth—no external incisions are required.

Why Do Patients Need TORE After Gastric Bypass?

After a successful gastric bypass, many patients experience significant weight loss. However, research shows that up to 30–40% of patients may regain a substantial amount of weight several years after the surgery. This is not always due to poor lifestyle choices—sometimes, it’s because of anatomical changes like:

Stretching of the stomach pouch
Widening of the outlet between the pouch and intestine

When the outlet becomes too large, food empties from the stomach too quickly, leading to less satiety, frequent hunger, and ultimately, more calorie intake. TORE helps restore the anatomy closer to its original post-surgical state and re-establishes the feeling of fullness.

How Does the TORE Procedure Work?

The TORE procedure is performed under sedation or general anesthesia and typically takes 30–60 minutes. Here’s how it works:

An endoscope is inserted through the patient’s mouth and down into the stomach pouch.
Using a specialized suturing system, the physician places stitches around the enlarged outlet, reducing its diameter.
In some cases, the stomach pouch itself may also be tightened to enhance restriction.

Patients typically go home the same day and can return to normal activities within a few days.

Benefits of TORE

Minimally invasive – no cutting, no scars, no hospital stay
Low risk of complications
Promotes renewed weight loss or stabilizes weight regain
Restores early satiety by slowing gastric emptying
Short recovery time – most people resume work within a few days

Studies have shown that patients can lose 10–15% of their total body weight within the first year after TORE, particularly when combined with lifestyle modifications and nutritional counseling.

Risks and Considerations

While TORE is considered safe, it still carries some risks, including:

Nausea or abdominal discomfort post-procedure
Sore throat (from the endoscope)
Rarely, bleeding, infection, or injury to the gastrointestinal tract

It’s also important to note that TORE is not a substitute for long-term dietary discipline and behavioral change. Patients who undergo this procedure should be committed to following a structured follow-up plan involving a registered dietitian, support groups, and physical activity.

Is TORE Right for You?

TORE is generally recommended for patients who:

Have regained a significant amount of weight after Roux-en-Y gastric bypass
Have an enlarged gastric outlet confirmed via endoscopy or imaging
Are medically stable and motivated to re-engage in a weight management program

It is not typically used for individuals who haven’t had previous bariatric surgery or who originally had a different type of procedure like gastric sleeve or lap band.