Endoscopic gastric suturing for weight loss: Techniques and outcomes

Abstract

With the growing epidemic of obesity, endoscopic bariatric therapies have evolved to help bridge the treatment divide between behavioral/pharmacologic therapies—which have limited efficacy—and bariatric surgical interventions—which are invasive and contraindicated in those with extensive medical comorbidities. Among endoscopic bariatric therapies, endoscopic suturing procedures focused on gastric remodeling have a promising foothold in the multidisciplinary management of obesity and its comorbidities given their safety, efficacy, and anticipated durability. Predicated on the twin goals of restricting gastric accommodation and delaying gastric emptying—thereby improving satiation and satiety, respectively—endoscopic suturing can facilitate clinically substantive weight loss with minimized risk to patients.Multiple variations of endoscopic suturing systems for management of obesity have been explored; however, the two endoscopic gastric suturing techniques that have demonstrated the greatest traction and promise include the endoscopic sleeve gastroplasty, typically created with the Apollo OverStitch (Apollo Endosurgery, Austin, TX), and the Primary Obesity Surgery Endoluminal (POSE) procedure, carried out through the transoral Incisionless Operating Platform (USGI Medical, San Clemente, CA). As such, the bulk of this review will primarily focus on the endoscopic sleeve gastroplasty and POSE procedures, their technical considerations, physiologic underpinnings, clinical and safety outcomes, and we will conclude with a discussion on the future directions of endoscopic suturing, including the POSE2 procedure.