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. 2021 Jun;35(6):2523-2530.
doi: 10.1007/s00464-020-07666-6. Epub 2020 Jun 24.

Re-suturing after primary endoscopic sleeve gastroplasty (ESG) for obesity

Gontrand Lopez-Nava #  1 , Ravishankar Asokkumar #  2   3 , Anuradha Negi  2 , Enrique Normand  2 , Inmaculada Bautista  2
Affiliations

Re-suturing after primary endoscopic sleeve gastroplasty (ESG) for obesity

Gontrand Lopez-Nava et al. Surg Endosc. 2021 Jun.

Abstract

Introduction: Although primary endoscopic sleeve gastroplasty (P-ESG) is effective, some patients may require revision procedures to augment weight loss. We hypothesized that a non-surgical approach using redo ESG (R-ESG) might be a viable option in such patients. We aimed to assess the safety and efficacy of R-ESG following P-ESG to treat obesity.

Methods: We reviewed the outcome of patients who underwent R-ESG at our unit. We classified them as weight loss failure (WF)-< 10% total body weight (TBWL) at 6-months; weight regain (WR)-lost ≥ 10% TBWL and regained 50% of the maximum weight loss at or after 1-year; weight plateau (WP)-lost ≥ 10% TBWL but could not lose further over 3-months. We analyzed the feasibility, safety, and evaluated the efficacy of R-ESG in each group.

Results: Of the 482 patients who underwent P-ESG, 35 (7%) required R- ESG (WF-12, WR-12, WP-11). The mean age, weight, BMI (38.2 kg/m2), and the number of sutures used during P-ESG were similar between the groups. The nadir %TBWL was lowest in WF group compared to WR and WP (6.5% vs. 20% vs. 22.4%, p = 0.001). The mean BMI at R-ESG was 33.6 kg/m2. The time to R-ESG was longer in the WR group compared to WF and WP (22.3 vs. 13.4 vs. 13.7 months, p = 0.03). We placed a median of 3 (range 2-6) sutures. R-ESG was technically successful, and no serious complications occurred. All except two patients were discharged on the same day. The overall %TBWL achieved by R-ESG was significantly higher in WP (26%) as compared to WF (11.2%) and WR (12%), respectively (p = 0.001).

Conclusion: The need for R-ESG after P-ESG is low. R-ESG is safe and induced weight loss in all patients. The maximum benefit was observed in WP.

Keywords: Bariatric endoscopy; Endoscopic sleeve gastroplasty; Obesity; Re-suturing; Weight regain.

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