de Moura DTH, et al. - Researchers performed a comprehensive evaluation of contributing factors to weight regain in a 55-year-old female with history of RYGB in 2006, referred to their unit for endoscopic evaluation. A large gastrojejunal anastomosis (GJA) (25 mm in diameter) was diagnosed during endoscopy. Then they performed a novel trans-oral outlet reduction (TORe). First, they performed a modified ESD on the GJA, followed by argon plasma coagulation of the margins of the ESD. Then they performed a purse-string TORe with suturing using a 10 mm balloon to size the GJA. The patient reported loss of 20 lb. on 6-month follow-up with 12.26 %TBWL and EGD showed a 10 mm diameter GJA. The patient reported a weight loss of 14 lb. and 8.58 %TBWL on 1-year follow-up. A 12 mm diameter GJA was noted on follow-up endoscopy. These findings suggest the safety, reproducibility, and efficacy of endoluminal therapies in the treatment of weight regain. Hence, to manage this condition, the therapies should be utilized as a first-line approach. They identified this novel-combined approach as feasible and findings suggested a possibility of it being more effective in the treatment of weight regain.