Background and Aims: Gastric plication involves inverting the stomach with tissue anchor placement to achieve serosa-to-serosa apposition. One potential application of gastric plication is the treatment of weight regain after Roux-en-Y gastric bypass (RYGB), a procedure also known as plication transoral outlet reduction (P-TORe). This study aims to assess technical feasibility, safety, and efficacy of P-TORe. Methods: This was a registry study of RYGB patients who underwent P-TORe for weight regain. The primary outcome was the amount of weight loss and clinical success rate, defined as percentage of total weight loss (TWL) of at least 5 at 12 months. Secondary outcomes were technical success, adverse events (AEs), and predictors of weight loss. Results: One hundred eleven RYGB patients underwent P-TORe. Average body mass index (BMI) was 38.5 +/- 7.5 kg/m(2). Baseline gastrojejunal anastomosis (GJA) and pouch sizes were 17 +/- 6 mm and 5 +/- 2 cm, respectively. The primary outcome was total weight loss, defined as patients experiencing 9.5 +/- 8.5 TWL at 12 months. Clinical success rate was 73. Technical success rate was 100. Argon plasma coagulation (APC) was performed around the GJA in all patients (100) before plication placement. The total number of plications per case was 7 +/- 3. Overall AE rate was 12.6. These included GJA stenosis (9.9), melena because of marginal ulceration (1.8), and deep vein thrombosis (.9). The severe AE rate was 0. Predictors of weight loss were the amount of weight regain and baseline pouch length. Conclusions: This novel P-TORe technique combining APC with gastric plication appears to be technically feasible, safe, and effective at treating weight regain after RYGB.
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