722 ENDOSCOPIC REVISION OF LAPAROSCOPIC SLEEVE GASTRECTOMY IS SAFE, EFFECTIVE, AND DURABLE: A MULTI-CENTER STUDY

Abstract

The laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery that facilitates approximately 60% excess body weight loss at five years; however, surgical revision for weight regain has been reported in over 10% of cases. Given the evolving role of endoscopic suturing as a therapeutic bariatric intervention, there is growing interest in endoscopic revision of LSG as a minimally-invasive alternative to surgical revision for weight recidivism. This study examined the procedural elements, outcomes, and safety associated with endoscopic revision of LSG. Seventy-seven adults at seven centers who experienced weight regain from post-LSG weight nadir underwent endoscopic revision to further restrict the surgical gastric sleeve using an endoscopic suturing device (OverStitch; Apollo Endosurgery, Austin, TX). Total body weight loss (TBWL) was followed (Figure 1). Univariate and multivariate analysis for TBWL >15% at 6 months post-revision was performed on inputs of age, weights, time to revision, use of weight loss medications, number of sutures, and presence of dilated stomach on baseline imaging (Table 1). Seventy-seven subjects (baseline mean age 42.27 years ± 10.73 years, 92% female) who had mean pre-LSG weight of 151.66 kg ± 71.00 kg and post-LSG weight nadir of 98.61 kg ± 41.94 kg experienced 21.35 kg ± 33.25 kg weight regain from post-LSG weight nadir, prompting endoscopic revision of LSG. At time of revision, mean weight was 117.90 kg ± 47.79 kg. The revisions occurred at a median of 5 (IQR 4-7) years after LSG and used median of 4 (IQR 3-4) sutures over a mean procedural duration of 46.90 min ± 19.28 min. After revision, TBWL was 5.85% ± 3.50% at one month (n = 63), 10.60% ± 4.58% at 3 months (n = 57), 13.68% ± 7.63% at 6 months (n = 47), and 12.75% ± 12.80% at 12 months (n = 38). At 3 month follow up, the 31% of subjects on weight loss medications at time of revision experienced 12.30% ± 4.41% TBWL compared to 9.06% ± 4.08% TBWL for those not on weight loss medications (p = 0.013). By 6 months, those on weight loss medications at time of revision experienced 14.50% ± 8.19% TBWL compared to 11.95% ± 6.92% TBWL for those not on weight loss medications (p = 0.32). Univariate analysis for association with TBWL > 15% at 6 months post-revision was significant for older age (OR 1.07, p = 0.038), and presence of dilated stomach on baseline imaging (OR 4.33, p = 0.026). There were no reported adverse events from the endoscopic revisions. Endoscopic revision of LSG is a safe and effective means of facilitating weight loss in those with weight regain after LSG and should be considered prior to pursuing more invasive surgical revision options. Concurrent use of weight loss medications with the revision appears to provide short term improvement in TBWL but this difference was not sustained at 6 months.Table 1Univariate and Multivariate Analyses. Factors associated with endoscopic revision of LSG to achieve TBWL > 15% at 6 months after post-revision were subjected to univariate and multivariate analyses. Statistically significant p values and odds ratios are bolded. Older age and presence of dilated stomach on baseline imaging prior to revision were associated with TBWL > 15% on univariate analysis. On multivariate analysis, greater weight at time of endoscopic revision was most correlated with achieving TBWL > 15% at 6 months.View Large Image Figure ViewerDownload Hi-res image Download (PPT)