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

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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.

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Abbreviations

TBWL:

Total body weight loss

EWL:

Excess weight loss

BMI:

Body mass index

ESG:

Endoscopic sleeve gastroplasty

SD:

Standard deviation

WF:

Weight loss failure

WR:

Weight regain

WP:

Weight plateau

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Author information

Author notes

  1. Gontrand Lopez-Nava and Ravishankar Asokkumar have contributed equally to this work and share the first authorship.

Authors and Affiliations

  1. Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain

    Gontrand Lopez-Nava, Ravishankar Asokkumar, Anuradha Negi, Enrique Normand & Inmaculada Bautista

  2. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore

    Ravishankar Asokkumar

Authors
  1. Gontrand Lopez-Nava
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  2. Ravishankar Asokkumar
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  3. Anuradha Negi
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  4. Enrique Normand
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  5. Inmaculada Bautista
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Corresponding author

Correspondence to Gontrand Lopez-Nava.

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Disclosures

Dr. Gontrand Lopez-Nava: Consultant for Apollo Endosurgery, USA; USGI Medicial, USA; Nitinotes Surgical, Israel. Dr. Ravishankar Asokkumar, Dr. Anuradha Negi, Mr. Enrique Normand, and Dr. Inmaculada Bautista have no conflicts of interest or financial ties to disclose.

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The study was conducted following the good clinical practice guidelines and adhered to the recommendation of the declaration of Helsinki.

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Lopez-Nava, G., Asokkumar, R., Negi, A. et al. Re-suturing after primary endoscopic sleeve gastroplasty (ESG) for obesity. Surg Endosc 35, 2523–2530 (2021). https://doi.org/10.1007/s00464-020-07666-6

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