Endoscopic sleeve plication for revision of sleeve gastrectomy
Figure 1. Fluoroscopic image comparing the intragastric lumen before and after ﬁnal sleeve revision with narrowed central lumen.
A 49-year-old woman had undergone a sleeve gastrectomy 2 years previously, with an initial weight loss of 60 pounds. This weight was regained over the past few months. Endoscopy and a barium meal demonstrated a mildly dilated sleeve. With the patient under general anesthesia, the endoscope was inserted into the stomach and the previously created sleeve gastrectomy suture line was clearly visualized. Two parallel anterior and posterior suture placement sites were mapped using argon plasma coagulation, starting from the incisura and extending to the gastroesophageal junction. A tissue helix was used to capture the muscularis propria. A running stitch with the endoscopic overstitch device allowed the anterior and posterior placement sites to be apposed with 2-0 suture. The stitch was tightened to approximate the opposing gastric walls. The suture line was created from anterior to midline to the posterior site in an
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1004 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 4 : 2015
M-shaped pattern to ensure adequate plication of the folds and prevention of a second internal lumen. Approximately 8 sutures were placed in an interrupted sequential stitch, creating the central length of the sleeve. A second layer of 2 sutures was added to reduce the gastric body further (Fig. 1; Video 1, available online at www.giejournal.org). This was conﬁrmed by an upper GI series 1 day later. The procedure time was 90 minutes. The patient has since lost 20 pounds. DISCLOSURE Michel Kahaleh is a consultant to Boston Scientiﬁc, Xlumina, Gore, MI Tech, and Pinnacle, and a consultant to and researcher for Maunakea. All other authors declare no ﬁnancial relationships relevant to this publication. Reem Z. Sharaiha, MD, Prashant Kedia, MD, Nikhil Kumta, MD, Louis J. Aronne, MD, Michel Kahaleh, MD, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA