Herbert M Hedberg, MD1, Michael B Ujiki, MD2. 1University of Chicago Medical Center, 2NorthShore University HealthSystem
Endoscopic sleeve gastrectomy (ESG) utilizes an endoscopic suturing device to plicate the greater curve of the stomach. This results in a residual tube-like stomach that resembles the anatomy of a laparoscopic sleeve gastrectomy. The procedure begins by marking lines on the anterior and posterior stomach mucosal surfaces using electrocautery or argon plasma coagulation. These lines serve as guidelines for suture placement. The suture path extends from the junction of the antrum and body distally, to the fundus proximally. The most proximal 3-4cm of the fundus is not sutured, to avoid excessive tension on the short gastrics, which may tear and bleed into the peritoneum.
Bites of tissue are taken in a counterclockwise, spiral pattern, with at least six bites of tissue per suture. The first bite is take at the anterior mark, then laterally over the greater curve, and then at the posterior mark. The next bite is back on the anterior mark, but advanced proximally 2-4cm. The suture line is completed with a second set of lateral and posterior bites, both also 2-4cm proximal than the priors. The suture is cinched and anchored, bringing the anterior, lateral, and posterior edges together, and forming the greater curve plication. Typically 7-9 sutures are sufficient to complete the procedure.
Long-term outcomes are not yet available for ESG, but early case series show 50-60% excess weight loss one year after the procedure. One publication with 20 month follow-up of eight patients showed >70% excess weight loss in 5/8 patients, whereas the remaining 3/8 had regained all weight initially lost. Serious complications are exceedingly rare. It is possible that with standardization and refinement of technique and patient selection, ESG may become an attractive option among endoscopic bariatric techniques.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87844
Program Number: V128
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo