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SSAT ''How I Do It'' Series: Bariatric

Kuwait: Endoscopic Sleeve Gastroplasty and Trouble Shooting

Obesity is a major risk factor for chronic diseases and constitutes a large burden on the health system. According to the National Institute of Health (NIH), bariatric surgery should be performed for patients with BMI >40 kg/m2 or BMI>35 kg/m2 with comorbidities. In patients with class I and II obesity without comorbidities, the best treatment option is still uncertain. Reduction of gastric volume via endoscopic transoral placement of full-thickness sutures, termed endoscopic sleeve gastroplasty (ESG), adds another minimally invasive option to the armamentarium of bariatric surgery.

Several reports indicate that only 1% of patients who qualify for bariatric surgery pursue surgical options due to the fear from risks and complications associated with bariatric surgery. Endoscopic techniques have emerged as effective treatments for obesity. Transoral endoscopic gastric volume reduction procedures, based on the endoluminal vertical gastroplasty, was introduced. It included only the superficial layer of the stomach by suction and without incorporating the deeper layers. Recently, reduction of gastric volume via endoscopic transoral placement of full-thickness sutures, termed endoscopic sleeve gastroplasty (ESG), has been described.

The endoscopic suture system OverStitchTM (Apollo Endosurgery, Austin, TX, USA), a Food and Drug Administration approved and commercially available endoscopic suturing device, aims to reduce the gastric lumen by creating a tubulization, mimicking sleeve gastrectomy surgery but without surgical resection of the fundus or body of the stomach. The cap-based suturing system achieves full-thickness plication of the stomach, allowing for a serosa to serosa approximation.

Possible mechanisms for weight loss of the procedure include delayed gastric emptying and alteration in gut hormones, but further research is needed to clarify the mechanisms of action. In addition, the long-term durability and predictors of poor response are yet to be defined.

The aim of this video is to show the technical details of ESG and troubleshooting during the procedure and how to solve it.

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