Endoscopic band ligation for weight loss

To the best of our knowledge, this is the first study to use endoscopic band ligation for weight loss in a 30-year-old woman, who had an initial weight of 85 kg (height 155 cm; body mass index [BMI] 35.4 kg/m²). Endoscopy was performed with the patient sedated using propofol. All ligatures were applied in the gastric body, starting at the distal body; five parallel rows were created, with the last one in the proximal body, using 33 bands ([Fig. 1]). The entire procedure was completed in 30 minutes. Oxygen was used for endoscopic air insufflation. Notably, no immediate complications occurred during endoscopy ([Video 1]).

Fig. 1 Endoscopic view showing the band ligation cap.

Video 1 Endoscopic band ligation for weight loss, with 33 bands applied in five parallel rows throughout the gastric body, producing well-healed linear scars on follow-up 1 month later.

The patient did well after the procedure and was discharged after 2 hours. In the first 3 days, she complained of mild nausea, vomiting, and epigastric pain, which were controlled by medications (pantoprazole 40 mg twice daily for the first month, plus antiemetics and antispasmodics on demand). For 2 weeks, she was given a fully liquid diet, followed by an 800-calorie soft diet for another 2 weeks. The patient reported early satiety following the procedure. Follow-up endoscopy after 1 month revealed nice linear scars of healed ulcers in the gastric body ([Fig. 2]), causing marginal narrowing of the lumen. In addition, the patient’s weight had decreased from 85 to 79 kg and her BMI from 35.4 to 32.9 kg/m², corresponding to a 7 % total weight loss and a 24 % excess weight loss after 1 month.

Fig. 2 Endoscopic views 1 month after the procedure showing nice linear scars of healed post-band ulcers in the body a on forward view; b on retroversion.

Endoscopic band ligation for weight loss is a novel technique that could assist in obesity management. The technique appears safe, repeatable, and cost-effective, with a short learning curve. Nevertheless, further large-scale studies are warranted using more bands, longer caps, and prolonged follow-up to assess the efficacy and safety of the technique as a primary and secondary endoscopic weight loss procedure [1] [2].

Endoscopy_UCTN_Code_TTT_1AO_2AN

Publication History

Article published online:
08 October 2020

• References

• 1 Keohane J, Berro W, Harewood GC. et al. Band ligation of gastric antral vascular ectasia is a safe and effective endoscopic treatment. Dig Endosc 2013; 25: 392-396
• 2 Jirapinyo P, Thompson CC. Endoscopic gastric body plication for the treatment of obesity: technical success and safety of a novel technique. Gastrointest Endosc 2020; 6: 1388-1394