Trimming the fat: endoscopic suturing for tightening of prior endoscopic sleeve gastroplasty

Published:September 10, 2016DOI:
      A 60-year-old woman, weighing 214 pounds with body mass index (BMI) 33.5 kg/m2, underwent successful endoscopic sleeve gastroplasty (ESG). One year after ESG she weighed 169 pounds: 45 pounds weight loss, 21% total body weight loss (TBWL), with BMI 26.5. However, her weight reached a plateau, and she reported a diminishing change in satiety. The result of a gastric emptying study was normal. A preliminary study showed a ESG-induced decrease in caloric consumption and slowing of gastric emptying. Given her weight plateau, diminishing change in satiety, and normal gastric emptying study result, tightening of the prior ESG was performed. Endoscopy revealed prior gastroplasty with loosened sutures (Fig 1A). An endoscopic suturing system was used to place running stitches. The stitches were cinched to approximate the opposing gastric walls. Two layers of sutures were placed to narrow the gastric lumen (Fig 1B). Gentamicin lavage was performed to reduce the resk of infection (Video 1, available online at The patient was discharged home the same day. An upper GI series showed no evidence of leak (Fig 1C). One month after the procedure, she weighed 156 pounds: an additional 13-pound weight loss and 8% TBWL. From her initial ESG, she lost 58 pounds and 27% TBWL, with improved BMI 24.4. ESG is a safe endobariatric procedure. This case highlights the repeatability of the procedure for further weight loss.
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      Figure 1A, Endoscopic sleeve gastroplasty after 1 year with loosening of prior sutures. B, Gastric body after tightening of gastric sleeve. C, Upper GI series after tightening demonstrating narrow gastric body with fundal reservoir (blue arrow).
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