Endoscopic Sleeve Gastroplasty in the Super Super Obese

Cici Zhang, MD, Gregory Haber, MD, Julio Teixiera, MD. Lenox Hill Hospital

This is a 49 yo super super obese, bedbound, male with hypertension and obstructive sleep apnea undergoing elective endoscopic gastric sleeve procedure. Due to his high risk for cardiopulmonary event and severe central obesity, he was not amendable to surgery at this time. The goal of this intervention is to perform a staged procedure to lower his BMI in order to perform a definitive bariatric surgery in the future.

The procedure begins with marking the sites of suture using electrocaudery device 3cm from pylorus. The sites are marked in groups of 3 triangulated points in sequence. Endoscopic suturing is initiated by approximating the stomach mucosa with the overstitch needle driver using an endoscopic grasping device. Once the adequate amount of tissue is placed between the two jaws of the overstitch, the suturing device is deployed.

After six stitches are completed, an endoscopic knot pusher is used to cinch the knot. The suture is cut using the overstitch device. Suturing proceeds from the antrum to the proximal gastric pouch in layers. 16 sutures were used during this procedure.

After completing the second row of endoscopic sutures, the new gastric lumen is visualized. A final endoscopic evaluation of the sleeve demonstrated a linear gastric lumen with intact mucosa.

The patient had an uneventful postoperative course. He was advanced to clear liquids on POD2 and was discharged to rehabilitation center on POD 5.

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