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Early Successful Experiences of Surgical Conversion of Endoscopic Gastric Plication to Roux-en-Y Gastric Bypass

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Abstract

Background

The primary obesity surgery endoluminal (POSE) procedure is an innovative incision-less endoscopic bariatric procedure that is increasingly used. However, variable weight loss response and recurrence post-endoscopic bariatric procedures have at times necessitated laparoscopic bariatric conversion. The safety and approach of conversion to laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB), however, have been an active point of discussion within revisional bariatric surgery.

Methods

This retrospective review of four consecutive patients is the largest description of medium-term postoperative outcomes and technical highlights of a laparoscopic conversion of POSE to RYGB. Chart review was completed to evaluate patients’ post-POSE clinical course and perioperative outcomes after surgical conversion.

Results

Early data suggests varied weight loss trajectory with POSE and marked improvement in weight response after surgical conversion. Qualitative review reveals successful single-staged conversions contrary to previous smaller case series describing staged conversions involving endoscopic removal of plications followed by RYGB. Review additionally reveals key perioperative considerations for successful conversions to include intraoperative endoscopy, upper gastrointestinal fluoroscopic studies, and at times computed tomography. The latter study and laparoscopic view of the post-POSE stomach challenge the prior notion that distal POSE allows for easy revision to LSG.

Conclusions

Our case series underscores the complex multifactorial nature of metabolic disease and the increasing importance of a conscientious approach to conversion bariatric surgery as the adoption of POSE and the bariatric patient population continues to grow.

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References

  1. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94.

    Article  PubMed  Google Scholar 

  2. Gys B, Plaeke P, Lamme B, et al. Endoscopic gastric plication for morbid obesity: a systematic review and meta-analysis of published data over time. Obes Surg. 2019;29:3021–9.

    Article  PubMed  Google Scholar 

  3. AlKhatry M, Rapaka B, Maselli DB, et al. Improvements in hepatic steatosis, obesity, and insulin resistance in adults with nonalcoholic fatty liver disease after the primary obesity surgery endoluminal 2.0 procedure Endoscopy. 2023; 55:1028–34

  4. Singh S, Bazarbashi AN, Khan A, et al. Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis. Surg Endosc. 2022;36:252–66.

    Article  PubMed  Google Scholar 

  5. Lopez Nava G, Asokkumar R, Laster J, et al. Primary obesity surgery endoluminal (POSE-2) procedure for treatment of obesity in clinical practice. Endoscopy. 2021;53:1169–73.

    Article  PubMed  Google Scholar 

  6. Jirapinyo P, Thompson CC. Gastric plications for weight loss: distal primary obesity surgery endoluminal through a belt-and-suspenders approach. VideoGIE. 2018;3:296–300.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jirapinyo P, Thompson CC. Endoscopic gastric body plication for the treatment of obesity: technical success and safety of a novel technique (with video). Gastrointest Endosc. 2020;91:1388–94.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Beitner M, Hopkins G. Conversion of endoscopic sleeve gastroplasty to laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2020;16:590–1.

    Article  PubMed  Google Scholar 

  9. Khoursheed M, Al-Ali J, Fingerhut A. Laparoscopic sleeve gastrectomy after endoscopic sleeve gastroplasty and primary obesity surgery endoluminal: technical aspects. Surg Obes Relat Dis. 2020;16:1370–1.

    Article  PubMed  Google Scholar 

  10. Lopez-Nava G, Asokkumar R, Rull A, et al. Bariatric endoscopy procedure type or follow-up: what predicted success at 1 year in 962 obese patients? Endosc Int Open. 2019;7:E1691-8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cheng Q, Tree K, Edye M, et al. Reversal of endoscopic sleeve gastroplasty and conversion to sleeve gastrectomy - two case reports. Int J Surg Case Rep. 2020;68:180–4.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Brigham and Women’s Hospital, Division of General and Gastrointestinal Surgery, Department of Surgery, 75 Francis St., Boston, MA, 02115, USA

    Thomas H. Shin, David Spector & Ali Tavakkoli

  2. Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, 75 Francis St., Boston, MA, 02115, USA

    Danse Bi, Pichamol Jirapinyo & Christopher C. Thompson

Authors
  1. Thomas H. Shin
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  2. Danse Bi
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  3. Pichamol Jirapinyo
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  4. Christopher C. Thompson
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  5. David Spector
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  6. Ali Tavakkoli
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Corresponding author

Correspondence to Thomas H. Shin.

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Key Points

•Varied weight loss and conversion risk require a better selection of POSE candidates.

•POSE to RYGB, not LSG, is achievable, positing a different conversion risk profile.

•Contrary to prior reports, single-staged POSE to RYGB is safe and effective.

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Shin, T.H., Bi, D., Jirapinyo, P. et al. Early Successful Experiences of Surgical Conversion of Endoscopic Gastric Plication to Roux-en-Y Gastric Bypass. OBES SURG (2024). https://doi.org/10.1007/s11695-024-07245-x

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  • DOI: https://doi.org/10.1007/s11695-024-07245-x

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