Endoluminal Greater Curvature Plication – a case series

Manoel Galvao Neto, MD, Natan Zundel, MD, Josemberg M Campos, MD, Alonso Alvarado, MD, Lyz B Silva, MD, Jorge Orillac, MD, Sohail Shaikh, MD, Eddie Gomez, MD, Erik Wilson, MD, Christopher Thompson, MD

Gastro Obeso Center, SP, Brazil; Florida International University, Miami, FL, USA; Universidade Federal de Pernambuco, Brazil; Clinica Hospital San Fernando, Panama; Brigham and Women’s Hospital, Boston, MA, USA

Endoscopic endoluminal greater curvature plication (EGCP) uses the OverstitchTM device (Apollo Endosurgery, Inc., Austin, Texas) to reduce stomach size through approximation of tissues in a minimally invasive way. This procedure mimics a sleeve gastrectomy, achieving weight loss through gastric lumen reduction and increased early satiety. We report the first case series of EGCP, evaluating safety, technical feasibility and short-term efficacy of the OverstitchTM endoscopic suturing device in primary treatment of grade I obesity.

Four subjects underwent EGCP at Clínica Hospital San Fernando, Panamá, in june 2012. Patients with a BMI of 30-35 Kg/m2, age between 18-60 years and failure of obesity clinical treatment were included. Main exclusion criteria were significant gastrointestinal diseases and previous digestive surgery.

Procedures were carried out in an inpatient basis, under general anesthesia. OverstitchTM is a cap-based suturing system mounted on a double-channel endoscope, designed to perform full thickness plications, using 2-0 prolene thread with a curved needle arm mounted to the tip of the endoscope. The procedure is done after endoscopic evaluation of the upper digestive tract and insertion of the overtube (Guardus, US EndoscopyTM). Interrupted sutures are placed in a way to “infold” the greater curvature creating a tube-like path, reducing gastric volume. Once completed, the OverstitchTM is removed and a gastroscope is inserted to evaluate the result.

Patient characteristics are summarized in table 1. All were female, with a mean age of 25.5 years (22-52). Mean operative time was 96 min (50-190), the longest procedure was in a J-shaped stomach, making plication more difficult. No intraoperative complications were recorded.

By protocol, patients stayed in the hospital overnight for observation and diet followed the clinic’s bariatric diet. All had pneumoperitoneum and light abdominal pain, treated with NSAIDs. Patient 2 presented nausea and vomiting, staying a full day in the hospital. A barium swallow was done to assess gastric anatomy.

After a 6 month follow-up, weight loss analysis is detailed in table 1. In a contrasted radiography, gastric lumen remains reduced, with an appearance similar to a sleeve gastrectomy. All patients refer early satiety, one refers mild nausea after ingestion of large amounts of food; no complications were reported.

EGCP is technically safe and feasible, with a low rate of mild adverse events. Pneumoperitoneum happened in all patients, showing that the stitches reach full thickness of gastric wall. Mean weight loss was 15.35 Kg, mean final BMI was 27.5 Kg/m2 and all subjects are satisfied with the results. Longer follow-up and larger case series are needed to confirm our findings.

Table 1. Patients baseline characteristics and follow-up weight analysis

Patient	Initial weight (Kg)	Initial BMI (Kg/m2)	Final weight (Kg)	Weigh loss (Kg)	% Weight loss	Final BMI (Kg/m2)
1	89.1	32.0	69.5	19.6	22.47	24.7
2	89.0	32.0	75.0	14.0	15.73	26.9
3	86.9	32.4	69.1	17.8	20.48	26.0
4	95.0	35.0	85.0	10.0	10.53	32.4
Mean	90.0 Kg	32.85 Kg/m2	74.65 Kg	15.35 Kg	17.3%	27.5 Kg/m2

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Session: Podium Presentation

Program Number: ET010