Reply to Jagtap et al.

We thank Dr. Jagtap and colleagues for their interest in our study. Indeed, an endoluminal therapy should not compromise further surgical therapy. This is one of the major reasons for looking at such therapies, instead of repeated surgeries, in the management of obese patients. When evaluating another endoluminal technique (transoral gastroplasty [TOGa]; Satiety Inc., Paolo Alto, California, USA) that has currently been abandoned, we already observed that it had no impact on the difficulty of performing further Roux-en-Y gastric bypass surgery, unlike sleeve gastrectomy or lapbands, which significantly prolong such redo surgery [1].

In our multicenter study [2], two patients underwent a sleeve gastrectomy 8 months and 11 months after endoluminal gastric reduction. They had lost 8 kg (25.5 % excess weight loss [EWL]) and 5 kg (20.2 % EWL) at this time and were unsatisfied. Both procedures were uneventful and the patients were discharged on day 2. Some inflammation around the sites of the transmural sutures was observed during surgery. There was no major change in the technique and only the material used for gastric stapling was adapted to allow for the thickness of the plicated stomach, with the use of larger staplers adapted for thicker tissue (GST60G green instead of GST60 W white; Ethicon, Johnson and Johnson, New Brunswick, New Jersey, USA). The third patient had a lapband performed in another institution at 8 months, after having lost 4 kg (23.2 % EWL) despite very poor compliance. No surgical problem was reported and he was discharged on day 1. Despite these therapies, 1 year later he had returned to his initial weight.

These observations suggest that this technique of endoluminal gastric reduction minimally affects further surgery, despite the persistence of plicatures and transmural sutures. This feature is probably of major interest in terms of finding the right place for endoluminal therapies in the management of obesity.

• References

• 1 Closset J, Germanova D, Loi P. et al. Laparoscopic gastric bypass as a revision procedure after transoral gastroplasty. Obes Surg 2011; 21: 1-4
• 2 Huberty V, Machytka E, Boškoski I. et al. Endoscopic gastric reduction with an endoluminal suturing device: a multicenter prospective trial with 1-year follow-up. Endoscopy 2018; 50: 1156-1162