Redo endoscopic sleeve gastroplasty: technical aspects and short-term outcomes

Abstract

Background: Endoscopic sleeve gastroplasty (ESG) is a restrictive endoscopic bariatric procedure providing promising results. In this short case series, we analyze the technical aspects and short-term outcomes of the redo ESG. Methods: A retrospective analysis was done on a prospective database of all patients that were selected by a multidisciplinary team that underwent ESG between March 2017 and May 2019. Patients that underwent a redo ESG because of a progressive loss of satiety, weight regain, or insufficient weight loss due to high baseline body mass index were included. Percentage of excess weight loss (%EWL), percentage of total body weight loss (%TBWL), and the Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire were evaluated during follow-up. Results: A total of 120 ESG procedures were performed with mean %EWL of 44.4% (± 19.5), mean %TBWL of 18.3% (± 6.7), and mean BAROS of 4.5 (± 1.7) at 12 months. Of those, four patients that underwent a redo ESG were identified. A total of three of them had a redo ESG after 12 months from the first ESG, whereas one of them had a redo ESG after 7 months. During the second procedure, old threads were removed with scissors and new stitches were positioned following a triangular pattern and avoiding overlap with the previous stitches. No adverse events were reported during the redo ESG. Six month follow-up was available for three patients, mean %EWL and %TBWL were 44.2% and 20.4%, respectively; BAROS questionnaire mean score was 6.3. One patient had only 1 month follow-up with a mean %EWL and %TBWL of 33.3% and 12.2%, respectively; BAROS questionnaire reported score was 6. All included patients reported excellent satiety feeling after redo ESG. Conclusions: The redo ESG short-term outcomes are completely satisfying in terms of safety and efficacy. The need to perform a redo ESG should not be considered as a failure of the previous procedure, but it can be considered as a second step of the endoscopic treatment strategy.

Laparoscopic sleeve gastrectomy versus endoscopic sleeve gastroplasty: a systematic review and meta-analysis

“…The recent emergence of bariatric endoscopic techniques promises less invasive, more cost-effective, and repeatable [5] approaches to the treatment of obesity. Endoscopic sleeve gastroplasty (ESG) consists of tubularization of the gastric cavity created by placing full-thickness sutures in a triangle and in a top-to-bottom direction from the gastric angulus towards the gastric fundus, preserving the area of the pyloric antrum and a part of the fundus itself.…”

Endobariatric procedures for obesity: clinical indications and available options

“…No peri-procedure complications were reported after the redo procedure, and all four patients reported excellent satiety after this redo procedure. 86 Although this study had a small sample, it showed promising results for a redo procedure.…”

Endoscopic sleeve gastroplasty is feasible after failed modified primary obesity surgery endoluminal procedure

“…A maximum of 4 bites was used 7 to avoid too much stirring of the stomach, which could lead to too much pressure on the gastric wall and eventually to gastric perforation. Adding too much pressure between the sutures should also be avoided to reduce the pressure on the stomach.…”

“…In case of failure of weight loss, redo ESG after primary ESG (both with Apollo Overstitch) has been proved to be safe and effective, with 100% of technical success and about 19% of total body weight loss within 1 year. 7,8 To our knowledge, ESG with Apollo Overstitch after failed POSE-2 procedure has not yet been described. Here, we describe the clinical results and technical aspects of the first case of ESG with Apollo Overstitch after a previous POSE-2 procedure.…”