Z Gastroenterol 2016; 54 - KV451
DOI: 10.1055/s-0036-1587227

OUTLET REPAIR using APOLLO OVERSTICH®- A new endoluminal procedure for WEIGHT REGAIN AFTER bariatric surgery (VIDEO)

C Ucta 1, C Benzing 1, F Krenzien 1, C Denecke 1, W Veltzke-Schlieker 2, A Adler 2, J Pratschke 1, R Zorron 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 propose a new endoscopic procedure to reduce the gastric pouch and anastomosis, potentially reversing the typical plateau after gastric bypass and applied in a pilot clinical series.

Methods: Endoscopic revision of gastric bypass, closure of gastrocutaneous fistula, and primary endoscopic sleeve plication were performed using the full-thickness suturing device Apollo Overstich®. Technical steps included:

  • Diagnostic endoscopy with measure of the pouch.

  • Insertion of the Overtube.

  • Argon burning of the whole anastomotic surface.

  • Lateral suturing of the edges of the anastomosis.

  • 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 revisions was 52 min. Follow-up showed satisfactory weight loss with no weight regain after 6 months.

Conclusions: Endoscopic revision with Apollo Overstich for weight regain after gastric bypass is a new non-invasive procedure with a low learning curve and satisfactory early results. The effectivity of the use of the device for primary endoscopic sleeve plication have to be analysed in further studies.