Bariatric endoscopy · London
TORe for weight regain after gastric bypass, without another operation.
A day-case endoscopic revision of the dilated gastro-jejunal anastomosis after RYGB - by a bariatric endoscopist with high Apollo OverStitch volume, inside a full bariatric MDT with surgeons, dietitians and psychologists in the same team.
Why patients choose us
- 01
A named bariatric endoscopist, in a bariatric MDT unit
Not a general upper GI list. A therapeutic endoscopist with high Apollo OverStitch volume, working alongside bariatric surgeons, dietitians and psychologists.
- 02
The right revision for the right regain
TORe is not always the answer. For a gastro-gastric fistula, a slipped pouch or true surgical failure we recommend RYGB revision or conversion - before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private TORe costs in London.
Indicative ranges across our partner units. Send your bypass history and recent weights, and we quote firm figures across two or three options.
In short
TORe under GA in our London network: £12,500-£18,500, home the same day.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Bariatric MDT review and diagnostic EGD with stoma measurement | £1,200–£1,800 | 60 min | 48 hours |
| TORe with Apollo OverStitch, GA, day case, all-inclusive | £12,500–£18,500 | 45–60 min | Same day |
| TORe plus 12-month GLP-1 and dietetic weight programme | £14,000–£22,000 | 12 months | Ongoing |
| Repeat TORe for late recurrence (at 2–3 years) | £10,500–£15,500 | 45–60 min | Same day |
| Surgical RYGB revision or SADI-S conversion referral | £18,000–£28,000 | 2–3 hours | 2–4 weeks |
| Second-opinion review of prior bariatric records | £300–£500 | 30 min | 48 hours |
Prices vary by unit, by which endoscopist does the case, by whether a 12-month GLP-1 and dietetic programme is added, and by whether a second suture line is needed. We come back with a firm quote within one working day.
The problem
Regain after RYGB is common, and it is not your fault.
Somewhere between 20% and 30% of bypass patients regain a meaningful proportion of their nadir weight by year five. Often the anatomy has changed - a stretched stoma feeds calories through too quickly and restriction is lost.
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Have you tried GLP-1 first?
For milder regain, a structured GLP-1 and dietetic programme is the right first step. TORe is offered when the mechanical problem is proven on endoscopy.
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Is the stoma actually dilated?
A diagnostic gastroscopy measures the gastro-jejunal stoma. TORe is only worthwhile when the outlet is 15-20 mm or wider - otherwise the answer is elsewhere.
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Should you go straight to surgery?
For a slipped pouch, gastro-gastric fistula or metabolic failure, laparoscopic revision or SADI-S conversion may be a better fit. We say so honestly.
The journey
From MDT to 12-month review - what happens, in order.
One team from the first message to the 12-month weight check - including the dietitian, the GLP-1 prescription and the psychologist if you need one.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us your bypass history and weights
A short, confidential form. Year of RYGB, nadir weight, current weight, symptoms of dumping or hypoglycaemia, and any prior imaging or endoscopy.
- 02
Before
We come back with a recommendation
Within one working day: whether TORe fits, or whether a GLP-1 programme, surgical revision or SADI-S conversion is the better call. Indicative price. An honest read either way.
- 03
Before
Bariatric MDT and diagnostic EGD
Surgeon, endoscopist, dietitian and psychologist review your case. A diagnostic gastroscopy measures the gastro-jejunal stoma and excludes gastro-gastric fistula and marginal ulcer.
- 04
On the day
Arrival at the unit
Arrival, consent and a chat with the endoscopist and anaesthetist. General anaesthetic with airway protection - this is not a sedation case.
- 05
On the day
The TORe itself
45 to 60 minutes. Argon plasma coagulation to the stomal rim, then two to four full-thickness OverStitch sutures in a purse-string, reducing the stoma to 8-12 mm.
- 06
On the day
Home the same day
A short recovery, written aftercare, and home within a few hours. You will need someone to collect you after the anaesthetic.
- 07
After
Diet progression and GLP-1 programme
Liquid diet for one week, pureed for one to two weeks, then normal by week four. PPI for 8 weeks. GLP-1 co-therapy and dietetic review over 12 months.
Typical end-to-end: 2-3 weeks to procedure. Diet progression: 3-4 weeks. MDT review: 3, 6, 12 months.
When it helps
When TORe is the right step - and when it is not.
The patterns of regain we see most, plus the anatomical findings that mean TORe is set aside in favour of GLP-1, surgical revision or SADI-S conversion.
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Weight regain ≥15% of nadir after RYGB
Regain of 15% or more of your lowest post-bypass weight, with imaging or endoscopy showing a dilated gastro-jejunal stoma of 15-20 mm or wider.
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Late dumping or reactive hypoglycaemia
Post-meal palpitations, sweating and hypoglycaemia three hours after eating - often driven by a wide stoma flooding the jejunum with sugar.
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Marginal ulcer with a wide outlet
A refractory marginal ulcer at the anastomosis, in the setting of a dilated stoma - TORe can be combined with ulcer therapy and PPI.
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Loss of restriction and early satiety
You no longer feel full on small meals - a classic symptom of a dilated stoma emptying the pouch too quickly.
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Regain despite good dietary adherence
You are doing the right things - protein first, portion control, exercise - and the weight is still climbing. A mechanical problem needs a mechanical fix.
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GLP-1 alone has plateaued
Semaglutide or tirzepatide got you part of the way back but the regain has stalled - TORe plus GLP-1 outperforms either alone.
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Not a candidate: gastro-gastric fistula
If your regain is driven by a fistula between the pouch and the excluded stomach, TORe will not help - you need a surgical revision.
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Red flag: rapid regain with vomiting
Rapid regain with new vomiting, dysphagia or GI bleeding needs urgent bariatric surgical review, not a private TORe booking.
Options in the pathway
TORe sits inside a wider bariatric revision pathway.
Non-surgical options first, then endoscopic revision, then surgery when the anatomy demands it. What each choice actually involves - and which fits which pattern of regain.
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Non-surgical first: GLP-1 and dietetics
For milder regain (under 15%) we start with a structured 6-12 month GLP-1 and behavioural programme. TORe is only offered when the stoma is clearly dilated and the mechanical problem is proven.
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TORe with Apollo OverStitch (purse-string)
The reference technique. Two to four full-thickness sutures in a purse-string pattern reduce the stoma to 8-12 mm. Around 10-15% total body weight loss at 12 months in published series.
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APC rim ablation plus OverStitch
Argon plasma coagulation to the stomal rim before suturing - the raw surface encourages tissue apposition and durable healing. Standard in most UK centres.
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TORe plus GLP-1 co-therapy
Combining TORe with semaglutide or tirzepatide from month one outperforms either alone - the mechanical restriction and the appetite signal work together.
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Repeat TORe at 2-3 years
If the stoma redilates and regain returns, a second TORe can be performed. Outcomes are broadly similar to the first procedure in appropriately selected patients.
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Surgical RYGB revision
For a slipped pouch, gastro-gastric fistula or true surgical failure, laparoscopic revision of the bypass is more invasive but definitive - offered where TORe is not the right answer.
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SADI-S or bypass conversion
For severe regain with metabolic disease, conversion of RYGB to a duodenal switch (SADI-S) may be considered by the bariatric surgeon - a bigger operation with bigger nutritional consequences.
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Second-opinion review
A specialist review of your prior bariatric records, imaging and endoscopy - sometimes the answer is a GLP-1 programme, not a repeat procedure.
Our vetted London network
A small panel of bariatric endoscopists, we picked them.
Consultant endoscopists with high Apollo OverStitch case volumes, in centres that run full bariatric MDTs. Introductions are made privately once we understand your case.
Selection criteria
How we choose every endoscopist in our network.
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Bariatric endoscopists with high Apollo OverStitch case volumes
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Bariatric MDT with surgeons, dietitians and psychologists in the same team
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Access to RYGB revision and SADI-S conversion when TORe is not the right call
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Integrated 12-month GLP-1 and dietetic follow-up, not a one-off procedure
- HCA The Wellington Hospital Bariatric Centre
- Chelsea and Westminster Private Advanced Endoscopy
- King’s Private Bariatric Unit
- Imperial Private, Charing Cross
- London Bridge Hospital Advanced Endoscopy
Safety and recovery
What to expect afterwards - honestly.
TORe is a well-established endoscopic revision. The things worth planning are the anaesthetic, the first week of nausea, the four-week diet progression and the 12-month GLP-1 and dietetic follow-up.
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General anaesthetic, day case
TORe is done under GA with airway protection because the OverStitch device is bulky. Most patients go home 3-4 hours after the procedure.
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Nausea for the first week
Transient nausea and mild epigastric discomfort are expected in the first 5-7 days as the stoma settles. Anti-emetics are given for a week.
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Bleeding is uncommon
Clinically significant GI bleeding occurs in under 1% of TORe cases. Most bleeding is managed endoscopically at the same sitting.
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Perforation is rare
Full-thickness perforation is reported in under 0.5% of TORe cases in published series. Recognised at the time and managed with clips or, rarely, surgery.
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PPI for 8 weeks
A twice-daily proton-pump inhibitor for 8 weeks protects the sutured anastomosis and reduces the risk of marginal ulceration.
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Liquid to pureed to normal - 3-4 weeks
Liquids only for week one, pureed and soft foods weeks two and three, normal texture from week four. Written diet plan and dietitian contact.
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Recurrence 15-25% at three years
The stoma can redilate over time. Around 15-25% of patients regain part of what they lost by year three - a repeat TORe is usually an option.
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GLP-1 co-therapy is not optional
Best 12-month outcomes come from TORe combined with a structured GLP-1, dietetic and behavioural programme. The procedure alone is a partial answer.
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Red flags after discharge
Severe abdominal pain, fever, persistent vomiting, black stools or vomiting blood - call the unit or go to A&E the same day.
Reading your TORe report
Your TORe report in four parts. Read the last one first.
Whichever unit does the case, the operative note keeps to the same shape.
A quiet reminder
Bariatric endoscopy language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the report before your MDT review, just ask.
- 01 Header
Bypass anatomy and stoma measurement
Year of RYGB, pouch size, and the pre-TORe gastro-jejunal stoma diameter in millimetres. Any gastro-gastric fistula or marginal ulcer is documented here.
- 02 Technique
APC, suture pattern and final stoma size
Whether APC rim ablation was performed, how many full-thickness OverStitch sutures were placed, purse-string or interrupted pattern, and the final stoma diameter after suturing.
- 03 Findings
Complications and immediate result
Any intra-procedure bleeding, suture failure, or airway concerns, and the endoscopist’s judgement on whether restriction has been restored to target.
- 04 Impression
Diet plan and follow-up
Read this first: the diet progression (liquid, pureed, normal), the PPI course, the GLP-1 plan and the dietetic and MDT follow-up schedule over 12 months.
Recognised by major UK insurers
Insurance cover for TORe is variable - many policies exclude bariatric revision. We confirm cover, or a self-pay quote, before booking.
Frequently asked
Everything we get asked about TORe.
Quick answers on eligibility, weight loss, cost, risks and how TORe compares with surgical revision.
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What is TORe (Transoral Outlet Reduction)?
TORe is an endoscopic revision of a stretched gastro-jejunal anastomosis after Roux-en-Y gastric bypass. Under general anaesthetic, an endoscopist uses the Apollo OverStitch device to place two to four full-thickness sutures in a purse-string, reducing the stoma from 15-20 mm back down to 8-12 mm. It restores restriction without another operation and is done as a day case.
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Who is a candidate for TORe?
Typically patients who have regained 15% or more of their nadir weight after RYGB, with a dilated gastro-jejunal stoma of 15-20 mm or wider on endoscopy, and no gastro-gastric fistula. TORe also helps selected patients with post-bypass dumping, reactive hypoglycaemia or a marginal ulcer at a wide outlet. A bariatric MDT reviews every case first.
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How much weight can I expect to lose?
Published series show around 10-15% total body weight loss at 12 months, and around 8-10% at three years, when TORe is combined with a structured dietetic and behavioural programme. Outcomes are meaningfully better when TORe is paired with a 12-month GLP-1 programme (semaglutide or tirzepatide) rather than done alone.
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How much does TORe cost privately in the UK?
Around £12,500-£18,500 all-inclusive for TORe as a day case under GA. A combined TORe plus 12-month GLP-1 and dietetic programme is £14,000-£22,000. A repeat TORe at 2-3 years is £10,500-£15,500. Surgical RYGB revision or SADI-S conversion is more (£18,000-£28,000) and is offered when TORe is not the right answer.
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What are the risks of TORe?
Nausea and mild epigastric pain for about a week are expected. Serious complications are uncommon: clinically significant bleeding occurs in under 1% and full-thickness perforation in under 0.5%. The main long-term issue is redilation of the stoma - around 15-25% of patients regain part of what they lost by year three, and a repeat TORe is usually an option.
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How is TORe different from a surgical bypass revision?
TORe is endoscopic, day case, done through the mouth with no incisions, and is fully reversible. Surgical revision of RYGB or conversion to SADI-S is a laparoscopic operation with a hospital stay, higher complication rate and more significant nutritional consequences - it is definitive but reserved for cases where TORe cannot solve the problem, such as a gastro-gastric fistula or a slipped pouch.
Ready to talk?
Send your bypass history. We reply within one working day.
One short form: year of RYGB, nadir and current weight, symptoms. We come back with a bariatric MDT recommendation and a firm quote.
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