P4839 - Comparative Effectiveness of Transoral Outlet Reduction (TORe) and Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Post-Bariatric Weight Regain: A Real-World Study

Ali Osman, MD, MSCI Candidate¹, Stuart K. Amateau, MD, PhD², Ahmed Dirweesh, MD²
1Washington University School of Medicine in St. Louis, Ballwin, MO; 2University of Minnesota Medical Center, Minneapolis, MN

Introduction: Transoral outlet reduction (TORe) and glucagon-like peptide-1 (GLP-1) receptor agonists represent distinct strategies for managing weight regain or inadequate weight loss after Roux-en-Y gastric bypass (RYGB). These treatments vary notably in their mechanisms of action and effectiveness, and although they may offer synergistic benefits in select patients, direct comparative effectiveness data remain limited. We aim to compare 1-year changes in BMI, and total body weight (TBW) between post-gastric bypass patients undergoing TORe and those prescribed GLP-1 therapy using real-world data.

Methods: This was a retrospective cohort analysis using the TriNetX federated database. Post-RYGB patients who received either TORe or GLP-1 receptor agonists were identified. Mean BMI and TBW were assessed at baseline and 1-year post-intervention. Outcomes included both absolute and percentage changes in BMI and TBW within each group.

Results: A total of 28 patients in the TORe group and 5,097 in the GLP-1 group had complete follow-up data. At 1 year, TORe led to a mean BMI reduction of 6.8 units (−17.04%) and a TBW reduction of 42 lbs. (−17.21%). In comparison, GLP-1 therapy was associated with a BMI reduction of 1.8 units (−4.76%) and TBW reduction of 10 lbs. (−4.41%).

Discussion: Both TORe and GLP-1 therapy resulted in meaningful BMI and TBW reductions over a 12-month period. TORe was associated with significantly greater improvements, supporting its role as a potent option for select patients with prior bariatric surgery.


Figure: Table 1:1-Year Change in BMI and Total Body Weight “(TBW)


Figure: Fig-1 BMI and total body weight before vs after intervention:TORe vs GLP-1 Therapy

Disclosures:
Ali Osman indicated no relevant financial relationships.
Stuart Amateau: BSC – Consultant. Cook – Consultant. Endo-Therapeutics – Consultant. Merit – Consultant. Olympus – Advisor or Review Panel Member, Consultant. Provation – Advisory Committee/Board Member. Steris – Consultant.
Ahmed Dirweesh indicated no relevant financial relationships.

Ali Osman, MD, MSCI Candidate¹, Stuart K. Amateau, MD, PhD², Ahmed Dirweesh, MD². P4839 - Comparative Effectiveness of Transoral Outlet Reduction (TORe) and Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Post-Bariatric Weight Regain: A Real-World Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.