Setting of an endoscopic bariatric gastric bypass (EBGP) : Is this endoscopic procedure could be an alternative to surgery ?

Aims Endoscopic sleeve gastroplasty is up to now the main endoscopic management to obtain significant weight loss. Endoscopic gastric bypass is not yet existing, leading to the lack of alternative compared to surgical bypass. We developed, during the last 6 years, a new endoscopic procedure with NOTES approach through the gastric wall, achieved with 5 experimental studies in pig: 4 new devices were created (special grasper dedicated to jejunum grasping, newly designed anastomotic LAMS, light beacon for measuring a 150 cm length of the bypassed limb, special device for occluding the pylorus) (Fig 1). They were included in a new NOTES procedure achieving a one -anastomotic gastric by pass (Endoscopic OAGB).

Methods 5 experimental studies were conducted on live pigs within 6 years, including 24 pigs (6 of them adult minipigs). 2 studies were comparative studies with sham pigs, 2 were performed aither following ESG, either were switched to bariatric surgery, one was the final assessment in adult (one year) obese minipigs. The mean follow-up was 4.5 months (3 to 9 months).

Results Technical success was 100% with an average length of the by-passed limb of 136 cm (80-170). Significant Weight loss was respectively 10.6 Kg and 11.1 kg in the 2 comparative series or compared to the expected growing curve in the 3 months old pigs. The whole procedure was completely reversible in all the cases by removing the LAMS stent from the gastro-jejunal anastomosis and the obstructing device from the pylorus. 19 pigs out of 24 survived at the end of the follow-up (2 volvulus and 3 from unknown origin despite a necropsy). Pathological findings in all the pigs showed no inflammation, adhesion, of infection on the serosa of the gastro-jejunal anastomosis or peritoneal cavity and microscopic findings showed complete fusion of the wall layers at the level of the anastomosis.

Conclusions EGBP with endoscopic OAGB) is a feasible and reproducible technique including reliable measurement of the bypass limb and reversibility. It could be an alternative to surgical bypass after the swith to human beings in pilot study.

Publication History

Article published online:
27 March 2025