Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Surgery, College of Medicine, King Saud University, and New You Medical Center, Riyadh, Saudi Arabia.
Gastrointest Endosc. 2021 Jan;93(1):122-130. doi: 10.1016/j.gie.2020.05.028. Epub 2020 May 27.
Laparoscopic sleeve gastrectomy (LSG) facilitates significant and durable weight loss; however, weight recidivism and need for revisional surgery occur in a subset of patients. Reduction of a dilated LSG using the revisional endoscopic sleeve gastroplasty (R-ESG) approach is an appealing and minimally invasive alternative to surgical revision that is congruent with obesity as a chronic relapsing disease model. In this study, we examine the safety and efficacy of the technique in a large multicenter international cohort.
Prospectively collected data from 9 centers for 82 consecutive adults who underwent R-ESG for weight regain after LSG using the OverStitch device (Apollo Endosurgery, Austin, Tex, USA) from March 2014 to November 2019 were reviewed. Total body weight loss (TBWL) and adverse events were reported up to 12 months. Univariable logistic regression was used to identify predictors of response at 12 months.
Eighty-two adults (92.7% female) experienced 27.9 ± 20.7 kg weight regain from post-LSG nadir weight, prompting R-ESG (mean age, 42.8 ± 10.4 years) at a mean weight of 128.2 ± 57.5 kg. Mean R-ESG procedure duration was 48.3 ± 20.5 minutes, and the median number of sutures used was 4 (interquartile range, 3-4). After R-ESG, TBWL (follow-up %) was 6.6% ± 3.2% at 1 month (81.7%), 10.6% ± 4.4% at 3 months (74.4%), 13.2% ± 10.1% at 6 months (63.4%), and 15.7% ± 7.6% at 12 months (51.2%). In a per-protocol analysis, ≥10% TBWL was achieved by 37 of 51 patients (72.5%) at 6 months and 34 of 42 patients (81.0%) at 12 months; ≥15% TBWL was achieved by 20 of 46 patients (43.5%) at 6 months and 22 of 42 patients (52.4%) at 12 months. Only 1 moderate adverse event occurred in the form of a narrowed gastroesophageal junction, which resolved after a single endoscopic dilation.
R-ESG is a safe and effective means of facilitating weight loss for weight recidivism after LSG, with sustained results at 1 year. R-ESG should be considered before pursuing more-invasive surgical revisional options.
腹腔镜袖状胃切除术（LSG）可显著且持久地减轻体重；然而，部分患者会出现体重反弹和需要进行修正手术。使用修正内镜袖状胃成形术（R-ESG）方法缩小扩张的 LSG 是一种有吸引力的、微创的替代手术修正方法，与肥胖作为一种慢性复发性疾病模型是一致的。在这项研究中，我们在一个大型多中心国际队列中检查了该技术的安全性和有效性。
前瞻性收集了 2014 年 3 月至 2019 年 11 月期间，使用 Apollo Endosurgery（美国得克萨斯州奥斯汀）的 OverStitch 装置对 9 个中心的 82 例连续成人 LSG 后体重反弹接受 R-ESG 的患者数据，这些患者的体重均有 27.9 ± 20.7kg 的反弹（从 LSG 术后最低点体重开始计算）。报告了 12 个月内的总体重减轻（TBWL）和不良事件。使用单变量逻辑回归来确定 12 个月时反应的预测因素。
82 名成年人（92.7%为女性）经历了 27.9 ± 20.7kg 的 LSG 术后最低点体重反弹，随后接受了 R-ESG（平均年龄 42.8 ± 10.4 岁），体重为 128.2 ± 57.5kg。R-ESG 手术平均持续时间为 48.3 ± 20.5 分钟，使用缝线中位数为 4 根（四分位距 3-4 根）。在 R-ESG 后，1 个月时 TBWL（随访%）为 6.6%±3.2%（81.7%），3 个月时为 10.6%±4.4%（74.4%），6 个月时为 13.2%±10.1%（63.4%），12 个月时为 15.7%±7.6%（51.2%）。在一项符合方案的分析中，6 个月时，51 名患者中有 37 名（72.5%）达到≥10%TBWL，42 名患者中有 34 名（81.0%）达到≥15%TBWL；6 个月时，46 名患者中有 20 名（43.5%）达到≥15%TBWL，42 名患者中有 22 名（52.4%）达到≥15%TBWL。仅 1 例中度不良事件为食管胃结合部狭窄，经单次内镜扩张后缓解。
R-ESG 是一种安全有效的方法，可促进 LSG 后体重反弹的体重减轻，且 1 年后仍有持续效果。在寻求更具侵入性的手术修正方法之前，应考虑 R-ESG。
