Gastroplasty with endoscopic myotomy as a revision procedure after weight regain after remote endoscopic sleeve gastroplasty.
Academic Article
Overview
abstract
BACKGROUND AND AIMS: Suture dehiscence and gastric sleeve dilation can cause post-endoscopic sleeve gastroplasty (ESG) weight regain. To our knowledge, gastroplasty with endoscopic myotomy (GEM) as a post-ESG revision technique has not been previously reported. We present a case of GEM successfully used after a primary ESG as a revision procedure. METHODS: A 52-year-old man had a weight of 111 kg in 2016 before ESG. Postprocedure, his weight reached 95 kg. However, he returned in 2023 with weight regain to 121 kg. GEM was decided after multidisciplinary discussion. Previous suture sites were appreciated. An antral myotomy was started with a bleb injected 8 cm proximal to the pylorus. The submucosal tunnel was entered by hybrid knife incision and dissected 2 cm before the pylorus. A partial full-thickness myotomy was performed with lysis of significant submucosal fibrosis. Gastroplasty was performed, and 8 suture bites were placed in a running modified "U" pattern to decrease gastric volume. RESULTS: There were no intraprocedure adverse events. At 3-month follow-up, the patient had lost 11 kg, and at 1-year follow-up, he had lost 20 kg. CONCLUSIONS: To our knowledge, GEM as a post-ESG revision has not been previously reported. Our case suggests that a post-ESG revision GEM with a modified "U" suturing pattern is feasible.
