Revision surgery after endoscopic sutured gastroplasty

We read with interest the recent study by Huberty et al. [1] and wish to congratulate the authors for this innovative work. This multicentric, single-arm, prospective trial evaluated the role of the Endomina triangulation platform (Endo Tools therapeutics, SA-ETT, Gosselies, Belgium) for gastric volume reduction in patients with class 1 and class 2 obesity. Out of 51 patients, 45 who completed 12 months of follow-up had 7.4 ± 7.0 % total body weight loss (TBWL) and 29.0 ± 28 % excess weight loss (EWL), without severe adverse events. As this study showed more than 5 % TBWL and more than 25 % EWL at 12 months, along with less than 5 % serious adverse events, it fulfils the preservation and incorporation of valuable endoscopic innovations (PIVI) criteria [2] [3] although, as there is no comparative cohort in this study [1], a statistically significant minimum difference of 15 % EWL between procedure and control is not available.

We would like to know more about the three patients who received additional surgery: two underwent sleeves and one a lapband. Though these patients were censored at the time of final analysis, it would be interesting to know about the indications for additional bariatric surgery. The authors should elaborate on whether surgery was done for technical or clinical failure of the endoscopic sleeve gastroplasty. The time interval between endoscopic sleeve gastroplasty and the decision to proceed to additional surgery could also be provided. It should be explained if there was any difficulty and challenge using the established technique during revision surgery.

Endoscopic gastroplasty has also been used as a revision for surgical sleeve gastrectomy failure [4]. In this retrospective study of five patients with failed surgical sleeve gastrectomy, endoscopic gastroplasty achieved a mean EWL of 33 % (range 13 % – 61 %) and a TBWL of 6.7 % – 17.2 %. If additional bariatric surgery after endoscopic gastroplasty is safe and effective, endoscopic gastroplasty could be used as bridging therapy for patients with morbid obesity (class 3).

• References

• 1 Huberty V, Machytka E, Boskoski 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
• 2 Abu Dayyeh BK, Kumar N. et al. ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc 2015; 82: 425-438 e5
• 3 Ginsberg GG, Chand B. et al. ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy. A pathway to endoscopic bariatric therapies. Gastrointest Endosc 2011; 74: 943-953
• 4 Eid G. Sleeve gastrectomy revision by endoluminal sleeve plication gastroplasty: a small pilot case series. Surg Endosc 2017; 31: 4252-4255