An illustration of a stomach

Revision of Gastric Bypass

Regained weight after a gastric bypass surgery? Reclaim your success with a non-surgical, minimally invasive revision procedure called transoral outlet reduction (TORe).

Authorized by FDA

Featured in top scientific publications

NIH National Library of Medicine PubMed Central American College of Gastroenterology ScienceDirect MDedge iGIE

What is transoral outlet reduction (TORe)?

Reverse weight regain

Weight regain after gastric bypass often occurs due to dilation of the gastric pouch and/or outlet. TORe+ and TORe (transoral outlet reduction) are a non-surgical, scar-free procedure that tightens the pouch and/or outlet to restore the original gastric bypass anatomy.

Tackling weight regain.
Post-bariatric surgery weight regain can be effectively addressed through non-surgical revisions by targeting the specific mechanisms contributing to weight gain.
Non-surgical. No scars.
Our revision procedures are performed endoscopically and avoid major incisions. This approach typically results in shorter recovery times, reduced risk of complications, and less post-operative discomfort compared to traditional surgery.
Quick recovery.
You can go home on the same day. Most patients take 1-3 days off work.
Happy woman with a diagram showing a revision of gastric bypass surgery

Purse-string TORe

Transoral outlet reduction (TORe) with argon plasma coagulation (APC) and purse-string

Discover purse-string TORe, which combines APC with a purse-string suturing pattern. This approach achieves an average weight loss of 10% compared to 3% with conventional TORe that uses APC and an interrupted pattern.

Average weight loss 1
Procedure duration
30 minutes

Purse-string TORe+

Transoral outlet reduction (TORe) with argon plasma coagulation (APC), purse-string, and endoscopic submucosal dissection (ESD)

Experience the most advanced TORe procedure globally. The integration of purse-string TORe and ESD allows for deeper stitching of the stomach layers, leading to the highest weight loss rates shown to last 5+ years.2 When combined with medications, TORe+ results in a 15% reduction in body weight, matching surgical outcomes.3

Average weight loss 1
Procedure duration
45 minutes


Who is TORe/TORe+ for?

Previous Roux-en-Y gastric bypass patients
with dilated pouches and/or outlets
Those who regained weight with body mass index (BMI) over 30
or between 27 and 29.9 with conditions such as high blood pressure, diabetes, high cholesterol, sleep apnea, or fatty liver disease
Revision of gastric bypass candidates
Quote from Courtney, a Bariendo gastric bypass revision patient


From 165 to 118 pounds - revision procedure was life-changing. It's not an end-all, but with work and dedication, the results are worth it. Do it!

Bariendo Revision of Gastric Bypass patient

How TORe and TORe+ work

The science behind TORe's efficacy

The TORe procedure tightens the stomach opening by sealing tissue with heat, stitching it in a circular pattern, and removing a thin layer of the lining.

Enhanced stitching with APC.
The standard TORe method uses argon plasma coagulation (APC) to remove the top stomach lining, enhancing stitching and resulting in more significant weight loss than stitching alone. Virtually all providers in the US use APC.
Durable results with the purse-string pattern.
Most providers use an interrupted stitch. Bariendo’s cofounders, Dr. Thompson and Dr. Jirapinyo, pioneered the purse-string pattern, using one suture for 8-14 stitches. This technique resists higher pressure and results in greater weight loss. It is for skilled providers.
Deeper layers, better results with ESD.
Endoscopic submucosal dissection (ESD) is an advanced technique that uncovers the stomach's deeper layers, allowing for deeper stitching. Dr. Christopher Thompson and Dr. Pichamol Jirapinyo pioneered its application to TORe.


Which TORe method is best for you?

Weight loss solution comparison
Purse-string TORe+
with APC, purse-string pattern, ESD
Purse-string TORe
with APC, purse-string pattern
Conventional TORe
with APC, interrupted pattern
Revisional surgery
Average weight loss
12-15% 1
10% 1
12-15% 4
Procedure duration
45 minutes
30 minutes
30 minutes
2-5 hours 5
Rare, fewer than 10 doctors in the US. Exclusive to Bariendo Greater Miami.
Limited. Available at all Bariendo locations.
Common. Not offered at Bariendo.
Common. Not offered at Bariendo.
Best for
Those willing to travel and schedule in advance
Cost and convenience seekers
Not recommended due to low weight loss rates
When weight regain isn't mainly due to the enlarged pouch/outlet

What sets us spart

Our revision procedures are unique

Bariendo’s TORe and TORe+ utilizes best practice protocols refined through a decade of research with year-long personalized support

We invented the procedures
Our co-founder, Dr. Christopher Thompson, invented and patented ESD-TORe, an endoscopic revision for gastric bypass, in 2018.
Exclusively endoscopic approach
While traditional revisions of prior bariatric surgeries are surgical, all of our revision procedures are endoscopic. This means they are non-surgical, leave no scars, and allow you to go home on the same day of the procedure with fast recovery.
Combination therapy with medications for enhanced weight loss
The emerging field of combining endoscopic procedures with weight loss medications is led by Dr. Jirapinyo, our co-founder. Our comprehensive treatment packages include prescribing a weight loss medication after the endoscopic revision procedure to further augment the amount of weight loss. (The costs of medication are not included; however, the medication may be covered by your insurance).
Sustainable lifestyle changes through a dedicated care team
Our support doesn’t end once the procedure is complete. For 12 months, you have direct access to a multidisciplinary team consisting of your physician, physician assistant, registered dietitian, exercise coach, and patient liaison. We also provide you with a smart scale that allows our care team to monitor your weight loss journey in real-time.

Frequently asked questions

Ready to take the next step?

Start your weight loss journey with doctors trusted by thousands.


  1. Jirapinyo P, de Moura DTH, Thompson CC. Endoscopic submucosal dissection with suturing for the treatment of weight regain after gastric bypass: outcomes and comparison with traditional transoral outlet reduction (with video). Gastrointest Endosc. 2020 Jun;91(6):1282-1288. doi: 10.1016/j.gie.2020.01.036. Epub 2020 Jan 31. PMID: 32007520; PMCID: PMC7245570.
  2. Jirapinyo P, Kumar N, AlSamman MA, Thompson CC. Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointest Endosc. 2020 May;91(5):1067-1073. doi: 10.1016/j.gie.2019.11.044. Epub 2019 Dec 7. PMID: 31816315; PMCID: PMC7183415.
  3. Jirapinyo P, Thompson CC. Combining transoral outlet reduction with pharmacotherapy yields similar 1-year efficacy with improved safety compared with surgical revision for weight regain after Roux-en-Y gastric bypass (with videos). Gastrointest Endosc. 2023 Oct;98(4):552-558. doi: 10.1016/j.gie.2023.04.2092. Epub 2023 May 5. PMID: 37150416.
  4. Dolan RD, Jirapinyo P, Thompson CC. Endoscopic versus surgical gastrojejunal revision for weight regain in Roux-en-Y gastric bypass patients: 5-year safety and efficacy comparison. Gastrointest Endosc. 2021 Nov;94(5):945-950. doi: 10.1016/j.gie.2021.06.009. Epub 2021 Jun 12. PMID: 34126065; PMCID: PMC8908793.
  5. Fulton, C., Sheppard, C., Birch, D., Karmali, S., & de Gara, C. (2017). A comparison of revisional and primary bariatric surgery. Canadian Journal of Surgery, 60(3), 205-211. doi: 10.1503/cjs.006116