Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy: an international, multicenter study

      Background and Aims

      Laparoscopic sleeve gastrectomy (LSG) facilitates significant and durable weight loss; however, weight recidivism and need for revisional surgery occur in a subset of patients. Reduction of a dilated LSG using the revisional endoscopic sleeve gastroplasty (R-ESG) approach is an appealing and minimally invasive alternative to surgical revision that is congruent with obesity as a chronic relapsing disease model. In this study, we examine the safety and efficacy of the technique in a large multicenter international cohort.

      Methods

      Prospectively collected data from 9 centers for 82 consecutive adults who underwent R-ESG for weight regain after LSG using the OverStitch device (Apollo Endosurgery, Austin, Tex, USA) from March 2014 to November 2019 were reviewed. Total body weight loss (TBWL) and adverse events were reported up to 12 months. Univariable logistic regression was used to identify predictors of response at 12 months.

      Results

      Eighty-two adults (92.7% female) experienced 27.9 ± 20.7 kg weight regain from post-LSG nadir weight, prompting R-ESG (mean age, 42.8 ± 10.4 years) at a mean weight of 128.2 ± 57.5 kg. Mean R-ESG procedure duration was 48.3 ± 20.5 minutes, and the median number of sutures used was 4 (interquartile range, 3-4). After R-ESG, TBWL (follow-up %) was 6.6% ± 3.2% at 1 month (81.7%), 10.6% ± 4.4% at 3 months (74.4%), 13.2% ± 10.1% at 6 months (63.4%), and 15.7% ± 7.6% at 12 months (51.2%). In a per-protocol analysis, ≥10% TBWL was achieved by 37 of 51 patients (72.5%) at 6 months and 34 of 42 patients (81.0%) at 12 months; ≥15% TBWL was achieved by 20 of 46 patients (43.5%) at 6 months and 22 of 42 patients (52.4%) at 12 months. Only 1 moderate adverse event occurred in the form of a narrowed gastroesophageal junction, which resolved after a single endoscopic dilation.

      Conclusions

      R-ESG is a safe and effective means of facilitating weight loss for weight recidivism after LSG, with sustained results at 1 year. R-ESG should be considered before pursuing more-invasive surgical revisional options.

      Abbreviations:

      EWL (excess weight loss), IQR (interquartile range), LSG (laparoscopic sleeve gastrectomy), R-ESG (revisional endoscopic sleeve gastroplasty), RYGB (Roux-en-Y gastric bypass), SD (standard deviation), TBWL (total body weight loss)
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      Linked Article

      • Revisional endoscopic sleeve gastroplasty: a new trick up our sleeves
        Gastrointestinal EndoscopyVol. 93Issue 1
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          Laparoscopic sleeve gastrectomy (LSG) permanently restricts the total gastric volume to induce weight loss. Beyond restricting the gastric capacity, its effectiveness is also accomplished by metabolic changes through increased gastric emptying and through changes in the secretion of enteric hormones such as ghrelin and glucagon-like peptide-1.1 It has been proved to be an effective bariatric surgery for many, although it is not without long-term failure.
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