Endoscopic augmentation of gastroesophageal junction using a full-thickness endoscopic suturing device

Abstract

Background and study aims This preliminary study was conducted to determine the feasibility and safety of endoscopic augmentation of the gastroesophageal junction (GEJ) using the Apollo OverStitch endoscopic suturing system in patients with gastroesophageal reflux disease (GERD) symptoms. Patients and methods Endoscopic augmentation of GEJ was performed on 10 consecutive patients and the data were analyzed retrospectively. Using a double-channel gastroscope affixed to the endoscopic suturing platform, interrupted sutures were placed on the gastric side of the GEJ in 2 layers in order to create a narrowed and elongated GEJ. Results Technical success was achieved in all patients, including those with a history of previous antireflux procedures (n = 7) and those with a hiatal hernia (n = 6). The median follow-up duration was 5 mo (range: 2 – 12). The median pre-procedure GERD-Health Related Quality of Life Questionnaire improved from 20 (range: 11 – 45) to a post-procedure score of 6 (range: 3 – 25) ( P = 0.001). The median duration of GERD symptom improvement after the procedure was 1 mo (range: 0.5 – 4). Adverse events were limited to 1 patient who developed nausea and vomiting, which was self-limited. Conclusions The use of a novel endoscopic suturing technique for the treatment of GERD is feasible and safe. The procedure resulted in short-term GERD symptom improvement. Further prospective studies using refined techniques are currently underway to improve durability and to prove efficacy.

Realignment of a Surgical Gastric Sleeve Using the Apollo Endoscopic Suturing Platform in a Patient With Postoperative Persistent Nausea and Vomiting

“…Current systems can replicate traditional surgical suturing patterns in the endoluminal environment. Available data include a study that proved the safety and efficacy of Apollo overstitch endoscopic suturing system in augmentation of gastroesophageal junction for the treatment of gastroesophageal reflux disease (GERD) [7,8].…”

Endoscopic Management of GERD

“…The OverStitch ® device (Apollo Endosurgery, Austin, Texas) was FDA approved in 2008 for endoscopic placement of suture(s) and approximation of soft tissue. We first reported a pilot series of ten patients in which endoscopic augmentation of the GEJ was performed using the OverStitch affixed to a double channel gastroscope with suturing performed in an antegrade fashion (unlike TIF which is performed in retrograde position) [ 70 ]. When first applied as an anti-reflux procedure, interrupted sutures were placed on the gastric side of the GEJ in two layers in order to create a narrowed and elongated GEJ.…”

Endoscopic Operating Platforms and Advancements

“…17 Recently, the Overstitch system has also shown benefit in endoscopic resection of type III gastrointestinal stromal tumors, treatment of gastroesophageal reflux disease, and further facilitation of ESD procedures. [18][19][20] A newer version of the system-the OverStitch Sx-launched in late 2018 is compatible with single-channel endoscopes, eliminating a key limitation of the original system (►Fig. 3).…”