TY - JOUR
T1 - Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy
T2 - an international, multicenter study
AU - Maselli, Daniel B.
AU - Alqahtani, Aayed R.
AU - Abu Dayyeh, Barham K.
AU - Elahmedi, Mohamed
AU - Storm, Andrew C.
AU - Matar, Reem
AU - Nieto, Jose
AU - Teixeira, Andre
AU - Al Khatry, Maryam
AU - Neto, Manoel Galvao
AU - Kumbhari, Vivek
AU - Vargas, Eric J.
AU - Jaruvongvanich, Veeravich
AU - Mundi, Manpreet S.
AU - Deshmukh, Ameya
AU - Itani, Mohamad I.
AU - Farha, Jad
AU - Chapman, Christopher G.
AU - Sharaiha, Reem
N1 - Funding Information:
DISCLOSURE: Dr Alqahtani has been a consultant for Apollo Endosurgery, Medtronic, and Johnson and Johnson and acted as proctor for Apollo Endosurgery. Dr Abu Dayyeh has been a consultant for Boston Scientific, Endo-TAGSS, USGI, DyaMx, and Metamodix; received grant/research support from Boston Scientific, USGI, Medtronic, Apollo Endosurgery, Cairn Diagnostics, Aspire, and Spatz; received speaker fees from Olympus, Medtronic, Johnson and Johnson, and Endogastric Solutions. Dr Storm has been a consultant for Apollo Endosurgery, GI Dynamics, and Endo-TAGSS; received grant/research support from Boston Scientific. Dr Nieto has been a consultant for Boston Scientific and Olympus. Dr Neto has been a consultant for Galvao Companies, Fractyl Labs, GI Dynamics, GI Windows, Apollo Endosurgery, USGI, Colubris Mx; acted as proctor for Fractyl Labs, GI Dynamics, Apollo Endosurgery, and USGI; been a Scientific Advisory Board member for DI Dynamics and Keyron; been on the faculty for training courses for Apollo Endosurgery, Ethicon Endo-Surgery, Medtronic, and Olympus. Dr Kumbhari has been a consultant for Apollo Endosurgery, Boston Scientific, ReShape Medical, Medtronic, and Pentax. Dr Mundi has received research grants from Fresenius Kabi, Nestle Health Sciences, and Realfood Blends; and has been a consultant for Baxter. Dr Chapman has been a consultant for Apollo Endosurgery, Boston Scientific, and Olympus. The other authors disclosed no financial relationships.
Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy
PY - 2021/1
Y1 - 2021/1
N2 - Background and Aims: Laparoscopic sleeve gastrectomy (LSG) facilitates significant and durable weight loss; however, weight recidivism and need for revisional surgery occur in a subset of patients. Reduction of a dilated LSG using the revisional endoscopic sleeve gastroplasty (R-ESG) approach is an appealing and minimally invasive alternative to surgical revision that is congruent with obesity as a chronic relapsing disease model. In this study, we examine the safety and efficacy of the technique in a large multicenter international cohort. Methods: Prospectively collected data from 9 centers for 82 consecutive adults who underwent R-ESG for weight regain after LSG using the OverStitch device (Apollo Endosurgery, Austin, Tex, USA) from March 2014 to November 2019 were reviewed. Total body weight loss (TBWL) and adverse events were reported up to 12 months. Univariable logistic regression was used to identify predictors of response at 12 months. Results: Eighty-two adults (92.7% female) experienced 27.9 ± 20.7 kg weight regain from post-LSG nadir weight, prompting R-ESG (mean age, 42.8 ± 10.4 years) at a mean weight of 128.2 ± 57.5 kg. Mean R-ESG procedure duration was 48.3 ± 20.5 minutes, and the median number of sutures used was 4 (interquartile range, 3-4). After R-ESG, TBWL (follow-up %) was 6.6% ± 3.2% at 1 month (81.7%), 10.6% ± 4.4% at 3 months (74.4%), 13.2% ± 10.1% at 6 months (63.4%), and 15.7% ± 7.6% at 12 months (51.2%). In a per-protocol analysis, ≥10% TBWL was achieved by 37 of 51 patients (72.5%) at 6 months and 34 of 42 patients (81.0%) at 12 months; ≥15% TBWL was achieved by 20 of 46 patients (43.5%) at 6 months and 22 of 42 patients (52.4%) at 12 months. Only 1 moderate adverse event occurred in the form of a narrowed gastroesophageal junction, which resolved after a single endoscopic dilation. Conclusions: R-ESG is a safe and effective means of facilitating weight loss for weight recidivism after LSG, with sustained results at 1 year. R-ESG should be considered before pursuing more-invasive surgical revisional options.
AB - Background and Aims: Laparoscopic sleeve gastrectomy (LSG) facilitates significant and durable weight loss; however, weight recidivism and need for revisional surgery occur in a subset of patients. Reduction of a dilated LSG using the revisional endoscopic sleeve gastroplasty (R-ESG) approach is an appealing and minimally invasive alternative to surgical revision that is congruent with obesity as a chronic relapsing disease model. In this study, we examine the safety and efficacy of the technique in a large multicenter international cohort. Methods: Prospectively collected data from 9 centers for 82 consecutive adults who underwent R-ESG for weight regain after LSG using the OverStitch device (Apollo Endosurgery, Austin, Tex, USA) from March 2014 to November 2019 were reviewed. Total body weight loss (TBWL) and adverse events were reported up to 12 months. Univariable logistic regression was used to identify predictors of response at 12 months. Results: Eighty-two adults (92.7% female) experienced 27.9 ± 20.7 kg weight regain from post-LSG nadir weight, prompting R-ESG (mean age, 42.8 ± 10.4 years) at a mean weight of 128.2 ± 57.5 kg. Mean R-ESG procedure duration was 48.3 ± 20.5 minutes, and the median number of sutures used was 4 (interquartile range, 3-4). After R-ESG, TBWL (follow-up %) was 6.6% ± 3.2% at 1 month (81.7%), 10.6% ± 4.4% at 3 months (74.4%), 13.2% ± 10.1% at 6 months (63.4%), and 15.7% ± 7.6% at 12 months (51.2%). In a per-protocol analysis, ≥10% TBWL was achieved by 37 of 51 patients (72.5%) at 6 months and 34 of 42 patients (81.0%) at 12 months; ≥15% TBWL was achieved by 20 of 46 patients (43.5%) at 6 months and 22 of 42 patients (52.4%) at 12 months. Only 1 moderate adverse event occurred in the form of a narrowed gastroesophageal junction, which resolved after a single endoscopic dilation. Conclusions: R-ESG is a safe and effective means of facilitating weight loss for weight recidivism after LSG, with sustained results at 1 year. R-ESG should be considered before pursuing more-invasive surgical revisional options.
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U2 - 10.1016/j.gie.2020.05.028
DO - 10.1016/j.gie.2020.05.028
M3 - Article
C2 - 32473252
AN - SCOPUS:85090484406
SN - 0016-5107
VL - 93
SP - 122
EP - 130
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 1
ER -