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133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

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APOLLO OVERSTICH – a New Procedure for Endoluminal Bariatric Surgery: Preliminary Clinical Experience

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  • Ricardo Zorron - Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Manoel GalvaoNeto - Gastrobeso Center, Bela Vista, São Paulo, Brazil
  • Sascha Chopra - Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Jürgen Ordemann - Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Christian Benzing - Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Felix Krenzien - Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Johann Pratschke - Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch531

doi: 10.3205/16dgch531, urn:nbn:de:0183-16dgch5315

Published: April 21, 2016

© 2016 Zorron et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Introduction: Gastric bypass for morbid obesity can induce important excess weight loss (EWL) during 2 years after surgery, and co-morbidities often improve or resolve. A weight plateau typically occurs as equilibrium in energy balance is reached after one year after surgery. Weight regain may be induced, among others, by anatomical factors as increased size of the anastomosis or gastric pouch, causing loss of restriction. We propose a new endoscopic procedure to reduce the gastric pouch and anastomosis, potentially reversing the typical plateau after gastric bypass and applied in a pilot clinical series.

Methods: Endoscopic revision of gastric bypass, closure of gastrocutaneous fistula, and primary endoscopic sleeve plication were performed using the full-thickness suturing device Apollo Overstich. Technical steps included:

1.
Diagnostic endoscopy with measure of the pouch.
2.
Insertion of the Overtube.
3.
Argon burning of the whole anastomotic surface.
4.
Lateral suturing of the .
5.
Sizing the GE with a 0.8 mm dilation balloon.

The patients were followed and documented regarding complications, weight loss and co-morbidities.

Results: Patients were submitted to the procedure without intraoperative complications. Mean operative time for revisions was 126 min. Follow-up showed satisfactory weight loss with no weight regain after 6 months.

Conclusions: Endoscopic revision with Apollo Overstich for weight regain after gastric bypass is a new non-invasive procedure with a low learning curve and satisfactory early results. The effectivity of the use of the device for primary endoscopic sleeve plication have to be analysed in further studies.

Figure 1 [Fig. 1]