Conversion to Gastric Bypass Is Technically Feasible After Endoscopic Gastroplasty

Bijan Abar, Maxwell Feinberg, Ryota Tanaka, MD, PhD, Michael B Ujiki, MD, FACS. NorthShore University HealthSystem.

INTRODUCTION – Endoscopic suturing devices have made it possible to perform less invasive procedures for obesity. Currently, it is not known whether an endoscopic sleeve gastroplasty would interfere with conversion to a gastric bypass. The purpose of this study was to assess technical feasibility of gastric pouch creation for a gastric bypass after an endoscopic sleeve gastroplasty.

METHODS AND PROCEDURES – Endoscopic sleeve gastroplasty was performed on three ex-vivo cadaveric human and one swine stomach. An endoscopic suturing system, Apollo Overstitch™, attached to a GIF TH-180 dual lumen upper endoscope was used to perform the procedures. Plications in a figure-of-eight suturing pattern were performed along the greater curvature with the help of a tissue helix device, permanent prolene sutures, and ceramic anchors. After successful gastroplasty, a gastric pouch was created with laparoscopic linear staplers simulating that performed during a gastric bypass. The resultant gastric pouch was measured, inspected, and tested for stapleline leaks.

RESULTS – Endoscopic sleeve gastroplasty was successfully performed in all four stomachs with an average of seven plications. There were no stapler misfires and all four stomachs were converted to gastric pouches with lengths (from GE valve to stapleline) ranging from 3.8-6.8cm and pouch widths of 3.5-15.2cm. Gastric pouch volume ranged from 14-69mls. Leak pressure ranged from 14.1-16.0mmHg in the human gastric pouches and 25.7mmHg in the swine.

CONCLUSIONS – Creation of a gastric pouch as in a gastric bypass with linear stapling devices is technically feasible after endoscopic sleeve gastroplasty.

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