Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy: an international, multicenter study

Maselli, Daniel B.; Alqahtani, Aayed R.; Dayyeh, Barham K. Abu; Elahmedi, Mohamed; Storm, Andrew C.; Matar, Reem; Nieto, José; Teixeira, André; Khatry, Maryam Al; Neto, Manoel Galvão; Kumbhari, Vivek; Vargas, Eric J.; Jaruvongvanich, Veeravich; Mundi, Manpreet S.; Deshmukh, Ameya; Itani, Mohamad I.; Farha, Jad; Chapman, Christopher G.; Sharaiha, Reem Z.

doi:10.1016/j.gie.2020.05.028

Cited by 45 publications

(20 citation statements)

References 44 publications

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“…6,7 These high-end devices can close large wounds and perform special operations, such as endoscopic sleeve gastroplasty. 13,14 These devices also require front-end installation on the endoscope before use. In addition, training is necessary for the proficient use of high-end suturing devices.…”

Section: Discussionmentioning

confidence: 99%

Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos)

Zhang

Jin²,

Shen³

et al. 2021

Gastrointestinal Endoscopy

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Background and Aims: We developed a through-the-scope twin clip (TTS-TC) for closing GI wounds. The objective of this study was to evaluate the efficacy and safety of the TTS-TC in GI wound closure.Methods: GI nonperforating and perforating wounds (!2.5 cm) were created in live pigs. TTS-TCs were used to convert the large wounds into small wounds. The remaining small wounds were closed using conventional throughthe-scope clips (TTSCs). The follow-up period was 1 month. Location and size of the wound, time of wound closure, intraoperative and postoperative adverse events, and conditions of wound healing were investigated.Results: Thirteen wounds were created in 5 live pigs, including 2 gastric nonperforating and 3 perforating wounds and 5 large intestinal nonperforating and 3 perforating wounds. The mean long and short diameters of the wounds were 4.1 (AE .9) cm and 3.4 (AE .7) cm, respectively. All wounds were successfully closed using the TTS-TCs combined with TTSCs. The total mean time for wound closure was 9.2 (AE 5.3) minutes, and the mean time for using the TTS-TCs was 3.9 (AE 4.7) minutes. During the 1-month follow-up period, no bleeding, perforation, or death occurred; all wounds healed with scar formation; and all TTS-TCs detached spontaneously. Conclusions:The TTS-TC was successfully used to close large-sized GI wounds. The TTS-TC is a promising tool for large-size wound closure under flexible endoscopy.Minimally invasive surgeries, such as endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFR), and natural orifice transluminal endoscopic surgery, are extensively used for treating GI diseases. A recent study also showed that wound closure after ESD might be useful in preventing delayed bleeding and perfo-ration. 1 Thus, wound closure is a common but challenging problem in these minimally invasive surgeries. [2][3][4] Firm and rapid closure of wounds plays an important role in patient prognosis, especially for perforating wounds. Currently, the main instruments 3-7 for wound closure while using a flexible endoscope are conventional through-the-scope Abbreviations: EFR, endoscopic full-thickness resection; ESD, endoscopic submucosal dissection; OTSC, over-the-scope clip; TTSC, through-thescope clip; TTS-TC, through-the-scope twin clip.

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Section: Discussionmentioning

confidence: 99%

Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos)

Zhang

Jin²,

Shen³

et al. 2021

Gastrointestinal Endoscopy

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“…Using the Overstitch device, a retrospective and multicenter study included 82 patients who underwent R-ESG after a mean weight regain of 27.9 AE 20.7 kg from their weight nadir. 48 After 1 year, the reported mean % EWL was 47.6%. Only one patient experienced stenosis at the gastroesophageal junction level that was successfully resolved with endoscopic dilation.…”

Section: Endoscopic Revisional Procedures After Sleeve Gastrectomymentioning

confidence: 97%

Interventions for Weight Regain after Bariatric Surgery

Muñóz

Soto

2021

Digestive Disease Interventions

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Bariatric surgery is the most effective available treatment for obesity, inducing a significant and durable weight loss, and improving several obesity-associated diseases. However, as the number of bariatric surgeries performed increases, so does the prevalence of patients who experience either insufficient weight loss or weight regain, accompanied by relapse or the emergence of new obesity-related diseases. Endoscopic and surgical bariatric revisional procedures are used to promote weight loss and improve metabolic function to address these problems. After a psychological, nutritional, medical, and anatomical evaluation of the gastrointestinal anatomy has been completed, patient candidacy to a revisional procedure must be defined. In those patients with insufficient weight loss or weight regain associated with relapse, the emergence of new obesity-related diseases, or quality-of-life deterioration, a revisional procedure must be selected. Although current evidence comes mainly from observational and retrospective studies, with a limited number of patients and short follow-up times, the available data indicate that revisional procedures are useful to induce a significant weight loss and/or promote remission of obesity-associated diseases, albeit an increased risk of surgical and/or nutritional complications. Thus, careful selection of patients is needed to minimize risk and maximize the benefit of these procedures.

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“…However, the trend of implementation of revisional ESG (R-ESG) is increasing, and more prospectively collected data are arriving. In a multicenter study, nine centers with 82 patients who underwent R-ESG for WR after LSG were treated using the OverStitch device[ 61 ]. The general purpose of R-ESG was to reduce the volume of the dilated gastric sleeve and shorten its length.…”

Section: Endoscopic Options In Revision Of Sleeve Gastrectomymentioning

confidence: 99%

Endoscopic therapy of weight regain after bariatric surgery

Bulajić¹,

Prampero²,

Boškoski³

et al. 2021

WJGS

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Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

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Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy: an international, multicenter study

Cited by 45 publications

References 44 publications

Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos)

Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos)

Interventions for Weight Regain after Bariatric Surgery

Endoscopic therapy of weight regain after bariatric surgery

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