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OverStitch/TORe (transoral outlet reduction endoscopy)
Transoral Outlet Reduction (TORe) for Weight Regain After Gastric Bypass
Transoral Outlet Reduction (TORe) is a minimally invasive endoscopic procedure used to help patients who have previously had gastric bypass surgery and are experiencing weight regain or less weight loss than expected.
After gastric bypass, the stomach pouch and the connection between the stomach and small intestine (the stoma) can gradually stretch over time. This may reduce the feeling of fullness after eating and contribute to weight regain. TORe is designed to reduce the size of both the pouch and the stoma to help restore restriction.
The procedure is performed using an endoscope (a flexible tube with a camera) passed through the mouth. A specialized suturing device, known as the OverStitch™ system, is used to place sutures that tighten the enlarged areas. Because the procedure is done internally, no external incisions are required.
What to expect:
TORe is typically performed on an outpatient basis
Most patients return to normal daily activities within a few days
Discomfort is generally mild and temporary
The procedure does not involve traditional surgery
TORe is performed by gastroenterologists trained in advanced endoscopic techniques. The approach is tailored to each patient’s anatomy and medical history.
Is TORe appropriate for you?
Patients who have had gastric bypass and are concerned about weight regain or reduced effectiveness of their surgery may be candidates for TORe. A consultation with a healthcare provider is needed to review your medical history, discuss potential risks and benefits, and determine whether this procedure is appropriate for your situation.
Small Bowel Capsule Endoscopy
Prep instructions here.
Video capsule endoscopy is a procedure used to examine the inside of your small intestine, an important part of the digestive system. This test is often suggested for investigating symptoms like ongoing stomach pain, bleeding, or conditions such as Crohn's disease or celiac disease. It's particularly useful when other tests, like endoscopies or colonoscopies, haven't provided clear answers.
During this procedure, you'll swallow a small capsule that's about the size of a vitamin pill. This capsule has a camera in it, which takes pictures of your small intestine as it travels through. These pictures are sent to a recording device you wear, giving your doctor a detailed view of your small intestine to help diagnose your condition. The procedure is non-invasive, meaning there are no cuts or incisions. You won't need any sedation, and you can carry on with most of your normal activities. The capsule is eventually passed naturally in your stool. Before undergoing video capsule endoscopy, it's important to talk to your healthcare provider. They will guide you on how to prepare, what happens during the test, and any specific instructions for after the test.
Upper Endoscopy
An EGD, or esophagogastroduodenoscopy, is a diagnostic procedure that helps doctors examine the inner lining of your esophagus, stomach, and the beginning of your small intestine (duodenum). This test is often recommended if you have symptoms like heartburn, upper abdominal pain, difficulty swallowing, or ongoing nausea and vomiting. It's also a valuable tool for investigating unexplained gastrointestinal bleeding and can aid in diagnosing conditions such as gastroesophageal reflux disease (GERD), stomach ulcers, or celiac disease.
During an EGD, a doctor uses a specialized instrument known as an endoscope – a flexible tube equipped with a camera and light. Before the procedure, you'll typically receive medication to help you relax. The endoscope is carefully inserted down your throat to provide a clear view of the upper gastrointestinal tract. This process allows for detailed imaging and, if necessary, biopsy for further analysis. The EGD procedure usually takes about 15 to 30 minutes and is performed on an outpatient basis. While some discomfort is possible, it is generally not painful. Discussing with your healthcare provider is key – they will guide you on preparing for an EGD, what the procedure involves, and the recovery process, including any potential risks and addressing your questions.
SUTAB Colonoscopy Prep (Spanish)
Instrucciones: haga clic aquí
Video con instrucciones: haga clic aquí
(nota: no recomendamos tomar un desayuno sólido la mañana antes del procedimiento; solo beba líquidos claros todo el día anterior)
SUTAB Colonoscopy Prep
For instructions in Spanish, click here
Video instructions from SUTAB: click here
(note: we do not recommend eating a solid breakfast the morning before the procedure; only drink clear liquids the entire day before)
Endoscopic Ultrasound (EUS)
Endoscopic Ultrasound (EUS) is an advanced diagnostic tool used to closely examine the digestive tract, including the esophagus, stomach, and parts of the small intestine, as well as surrounding organs like the pancreas and gallbladder. While EUS is an important tool in assessing and staging certain types of cancers, it has a wide range of other applications. It's frequently used to investigate causes of abdominal pain or abnormal findings from other tests, to evaluate conditions like pancreatitis or gallstones, and to understand the extent of certain digestive diseases.
In an EUS procedure, a doctor uses an endoscope that has an ultrasound device attached. This endoscope is carefully inserted into the digestive tract through the mouth or rectum. The ultrasound component produces detailed images of the internal structures, offering more clarity than external ultrasound. EUS can also be used to collect tissue samples for biopsy, helping to diagnose various conditions accurately. The procedure is minimally invasive, usually done on an outpatient basis, and requires some preparation similar to other endoscopic exams. It's important to discuss any concerns with your healthcare provider, who will provide detailed information about preparing for the EUS, what to expect during the examination, and the follow-up process.
Esophageal pH Testing
If you have heartburn, acid reflux (GERD), non-cardiac chest pain, or issues with swallowing, your doctor may refer you for pH testing. We offer two types of esophageal pH testing: pH with impedence testing and BRAVO pH testing. Please discuss with your doctor which may be the right test for you.
24 Hour pH Test with Impedence
pH testing with impedance involves wearing a small, thin tube (catheter) that goes through your nose and into your esophagus. This catheter has sensors that measure acid and non-acid reflux by detecting any liquid and gas that comes up into your esophagus. This test is typically done over a 24-hour period, during which you can go about your usual activities. It helps doctors see if your symptoms are related to acid reflux and how often reflux happens.
BRAVO pH Test (Wireless)
The BRAVO test uses a small capsule, temporarily attached to the esophagus wall during an endoscopy. This capsule wirelessly transmits pH levels to a recording device you wear. The BRAVO test is less invasive than traditional pH testing with impedance, as there's no catheter in your nose and throat. It usually monitors your acid levels for 48 to 96 hours. This test is particularly useful for understanding long-term acid exposure and its correlation with your symptoms.
Barrett’s Esophagus Radiofrequency Ablation
Barrett's Esophagus is a condition where the lining of the esophagus changes, often due to long-term acid reflux or GERD (Gastroesophageal Reflux Disease). People with Barrett's Esophagus have a higher risk of developing esophageal cancer. That’s why monitoring and treatment, like Radiofrequency Ablation (RFA), are important. Most people with Barrett’s Esophagus don't have symptoms, but it’s usually found during tests for GERD.
RFA is a treatment used for Barrett’s Esophagus, especially when there are precancerous changes. In RFA, a doctor uses a special device that sends out radio waves (radiofrequency energy) to remove the abnormal esophagus lining. The procedure is done during an endoscopy, where a thin, flexible tube with a camera is passed down your throat. RFA is effective because it targets only the abnormal cells, leaving the healthy ones untouched. This helps reduce the risk of esophageal cancer.
Before RFA, you’ll get instructions on how to prepare, usually involving fasting for a short time. The procedure is usually quick, and you won’t feel pain because you’ll receive medication to make you comfortable. After RFA, you might have some mild side effects like a sore throat, but these usually go away quickly. Most people can return to their normal activities soon after.
If you have Barrett’s Esophagus or are experiencing long-term heartburn or acid reflux symptoms, talk to your healthcare provider. They can advise on screenings for Barrett's Esophagus and discuss whether RFA or other treatments are right for you. Regular monitoring and timely treatment are key in managing Barrett's Esophagus and preventing more serious conditions.
Covid-19 Information: Updated as of May 2022
Committed to safe, excellent care
During the Covid-19 pandemic, it is important to get the care you need—whatever they may be. Integrated Gastroenterology Consultants providers, nurses and staff are ready to provide you with exceptional care.
Our office staff follows CDC and state-recommended guidelines to keep you safe. Masks are worn by all staff and patients to keep you safe. If you are having a procedure, depending on the location of your procedure and your vaccination status, you may need COVID testing prior. We currently have a testing area on site to help you prior to your procedure.
Symptoms
To help us safely care for you, please notify us of any upper respiratory symptoms you may have, such as:
New or worsening fever
Cough
Sore throat
Runny nose/nasal congestion
Shortness of breath
Muscle aches
Inability to smell or taste
Positive responses would likely indicate a deeper discussion with the provider before proceeding.
Knowing your symptoms will help us determine the most appropriate setting in which to treat you.