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Background: Transoral outlet reduction (TORe) is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass (RYGB) for weight recurrence; however, little has been published on its clinical implementation in the community setting., Aim: To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB., Methods: This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022. Patients were provided longitudinal nutritional support via virtual visits. The primary outcome was total body weight loss (TBWL) at twelve months from TORe. Secondary outcomes included TBWL at three months and six months; excess weight loss (EWL) at three, six, and twelve months; twelve-month TBWL by obesity class; predictors of twelve-month TBWL; rates of post-TORe stenosis; and serious adverse events (SAE). Outcomes were reported with descriptive statistics., Results: Two hundred eighty-four adults (91.9% female, age 51.3 years, body mass index 39.3 kg/m 2 ) underwent TORe an average of 13.3 years after RYGB. Median pre- and post-TORe outlet diameter was 35 mm and 8 mm, respectively. TBWL was 11.7% ± 4.6% at three months, 14.3% ± 6.3% at six months, and 17.3% ± 7.9% at twelve months. EWL was 38.4% ± 28.2% at three months, 46.5% ± 35.4% at six months, and 53.5% ± 39.2% at twelve months. The number of follow-up visits attended was the strongest predictor of TBWL at twelve months (R 2 = 0.0139, P = 0.0005). Outlet stenosis occurred in 11 patients (3.9%) and was successfully managed with endoscopic dilation. There was one instance of post-procedural nausea requiring overnight observation (SAE rate 0.4%)., Conclusion: When performed by an experienced endoscopist and combined with longitudinal nutritional support, purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB., Competing Interests: Conflict-of-interest statement: Dr. Daniel B Maselli is a consultant for Apollo Endosurgery, with no proprietary relationship. Dr. Christopher E McGowan previously served as a consultant for Apollo Endosurgery from 2019-2022, with no proprietary relationship. Dr. Vibhu Chittajallu, Dr. Lauren L Donnangelo, Dr. Brian Coan, Mr. Chase Wooley, Ms. Areebah Waseem, Ms. Michelle Secic, and Mr. Daniel Lee have no conflicts of interest or financial ties to disclose., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)