The Utility of Endoscopic Overstitch in Bariatric Patients at a Tertiary Care Center

Christine Boumitri, MD, Mohsen Hasanin, MD, Roger De La Torre, MD, Ghassan Hammoud, MD, MPH. University of Missouri- Columbia, MO

Background: Endoscopic suturing has gained success over the last few years since the Food and Drug Administration (FDA) approved the first endoscopic suturing device in 1998. These devices have evolved over the years and currently the OverStitch device (Apollo Endosurgery Inc., Austin, TX) is being used to close gastrointestinal defects, anchor luminal metal stents as well as in the management of weight gain in selected patients who underwent Roux-en-Y Gastric Bypass (RYGB) surgery.

Methods: We retrospectively reviewed our records of all patients that underwent endoscopic suturing using the OverStitch device between July 2015 and December 2015. We analyzed demographic information as well as outcomes of the procedures and complication rates.

Results: The OverStitch device was used on 10 patients (Males, n= 3; Females, n= 7). The indications for procedures were stent anchorage (n =4), reduction of dilated gastrojejunal anastomosis after RYGB surgery (n =4) and fistula closure (n =2). The Median age was 49 years [29-62 years] and the Median follow up was 45 days [10-103 days]. Two patients had esophageal metal stents placement for benign esophageal strictures and two patients for refractory gastrojejunal anastomotic stricture. Fifty percent (n=2) of the patients had early removal of stents (Median =34.5 days) due to patients’ intolerance to stent placement.  None of the stents migrated within the follow-up period. All patients in the stoma reduction group lost weight (Median 2.4 kg) during the follow-up period. One patient in the stoma reduction group required a repeated intervention with endoscopic suturing to reduce stoma size. Patients who underwent endoscopic closure of fistula achieved complete closure of persistent chronic gastro-gastric (n=1) and gastro-cutaneous (n=1) fistulas after failing over the scope and through the scope clips. The technical success rate of endoscopic overstitch was 100% with no reported complications related to endoscopic suturing.

Conclusion: The OverStitch device appears to be a beneficial tool in assisting the endoscopist in managing selected patients after bariatric surgery.