What question did this study set out to answer?

To evaluate the effectiveness of Transoral Outlet Reduction Endoscopy (TORE) for managing resistant dumping syndrome (DS) post-bariatric surgery.

February 8, 2026Open Access

Use of transoral outlet reduction endoscopy (TORE) in the management of resistant dumping syndrome

Key Points

To evaluate the effectiveness of Transoral Outlet Reduction Endoscopy (TORE) for managing resistant dumping syndrome (DS) post-bariatric surgery.
Identified patients with symptoms of dumping syndrome discussed in a bariatric MDT.
Assessed suitability for TORE via upper gastrointestinal endoscopy to evaluate pouch length and gastro-jejunostomy size.
Data collected on patient demographics and treatment responses.
Seventeen patients treated with TORE; median age was 45 years.
Complete response to treatment observed in 66% of patients after 2 years.
Four patients did not respond to TORE and are being considered for further surgical intervention.

Abstract

Abstract Introduction Dumping Syndrome (DS) and Reactive Hypoglycaemia (RH) are common occurrences post bariatric surgery, particularly post Roux-En-Y Gastric Bypass (RYGB). We present our initial results using Transoral Outlet Reduction Endoscopy (TORE) in the management of patients who failed to respond to dietary and medical treatment for DS. Methods All patients identified to have symptoms consisting with DS were discussed in the complex bariatric MDT and assessed for suitability of TORE via an upper gastro-intestinal endoscopy to assess the length of the pouch, size of the gastro-jejunostomy and the presence of alternative pathologies. Results Since the onset of our TORE services in January 2025, we identified 17 patients for treatment with TORE. The median age was 45yrs (IQR 36–55). Sixteen patients (94%) were women and all patients scored ≥ 7 on the Sigstad scoring questionnaire. Two patients had previously undergone conversion of gastric sleeve to a RYGB whilst all others had a primary RYGB. 2 patients were found to have unfavourable anatomy and was not safe to proceed with the procedure whilst one patient was followed up privately hence no data were available for review. The data showed a complete response to treatment at 2 years for 66% of patients. Four patients did not respond to treatment with TORE and are being considered for surgical intervention. Conclusions TORE is an effective treatment for patients with DS not responsive to medical and dietary therapy. We believe it is an effective non-surgical treatment method prior to considering reversal of the original surgery (RYGB) with its associated weight regain. Further work is planned to assess its outcomes in larger groups of patients. Graphical Abstract

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