Sleeve gastrectomy revision by endoluminal sleeve plication gastroplasty: a small pilot case series

Abstract

Background: The necessity for reoperation due to insufficient weight loss after bariatric surgery has led to a novel endoluminal plication of the gastric sleeve using a endoscopic suturing device. Advances in endoluminal endoscopy and other minimally invasive bariatric surgeries have inspired innovative techniques and have produced reliable suturing tools for gastric volume reduction.

Methods: Retrospective pilot case series of 5 patients with an enlarged gastric sleeve.

Results: The data show a sustained weight loss for all patients ranging from 19 to 36 lbs at 1 year, with the greatest average weight loss (27 lbs) observed at 6 months. At 1 year post-op, the mean body mass index was 33 kg/m². Four of the patients were considered successful, with a excess weight loss (EWL) sustained at 1 year post-procedure, ranging from 21 to 61% with a mean of 38%. One patient experienced a EWL of only 13%, which was attributed to failed lifestyle modification. The mean EWL of the series is 33%. The percent total weight loss (%WL) ranged from 6.7 to 17.2%.

Conclusions: The endoluminal approach with an endoscopic suturing device for sleeve revision by plication is showing early promising results and expands the management of weight gain following laparoscopic sleeve gastrectomy. This simple approach may offer a significant option for these patients as an interventional strategy in the early phases of weight regain, and prior to reaching a BMI of 40 kg/m², such as the traditional surgical approach.

Keywords: Endoluminal; Endoscopic; Endoscopic plication; Sleeve gastrectomy; Sleeve revision; Weight gain.