Z Gastroenterol 2016; 54 - KV412
DOI: 10.1055/s-0036-1587187

Endoscopic Sleeve Gastroplasty ESG using APOLLO OVERSTICH®- A new procedure for endoluminal bariatric surgery- preliminary experience

R Zorron 1, C Benzing 1, F Krenzien 1, C Denecke 1, C Ucta 1, W Veltzke-Schlieker 2, A Adler 2, J Pratschke 1
  • 1Charité – Universitätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Berlin, Deutschland
  • 2Charité – Universitätsmedizin Berlin, Division Interdisciplinary Endoscopy, Department for Hepatology and Gastroenterology, Campus Virchow Klinikum, Berlin, Deutschland

Introduction: Gastric bypass for morbid obesity can induce important excess weight loss (EWL) during 2 years after surgery, and co-morbidities often improve or resolve. A weight plateau typically occurs as equilibrium in energy balance is reached after one year after surgery. Weight regain may be induced, among others, by anatomical factors as increased size of the anastomosis or gastric pouch, causing loss of restriction. We describe our clinical experience with endoscopic outlet repair to reduce the gastric pouch and anastomosis, and also a new primary endoscopic procedure-ESG.

Methods: Primary endoscopic sleeve plication (ESG, first German series), Endoscopic revision of gastric bypass (Outlet repair), and closure of gastrocutaneous fistula were performed using the full-thickness suturing device Apollo Overstich®. For ESG, five to seven stiches were performed in the greater curvature. Technical steps for revisions included:

  • Diagnostic endoscopy with measure of the pouch.

  • Insertion of the Overtube.

  • Argon burning of the whole anastomotic surface.

  • Lateral suturing of the.

  • Sizing the GE with a 0.8 mm dilation balloon. The patients were followed and documented regarding complications, weight loss and co-morbidities.

Results: Patients were submitted to the procedure without intraoperative complications. Mean operative time for ESG was 126 min and for revisions 52 min. Follow-up showed satisfactory weight loss with no weight regain after 6 months.

Conclusions: Endoscopic primary ESG and revisions with Apollo Overstich® for weight regain after gastric bypass are new promising non-