S2551 Endoscopic Re-sleeve Is an Effective and Repeatable Treatment for Weight Regain Following Surgical Sleeve Gastrectomy: A Case Presentation

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Introduction: Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric surgery in the United States. Weight regain is common with up to 70% of patients reporting weight regain at 6 years follow-up. Endoscopic revision (re-sleeve) has emerged as an effective, safe and less-invasive alternative to surgical revision. We describe the case of a patient who had weight regain five years following LSG and after a first endoscopic revision, treated with repeat re-sleeve with excellent outcomes. Case Description/Methods: A 47-year-old female with a history of obesity and related complications presented for further evaluation. She previously had LSG with significant initial weight loss; but experience weight regain. She then underwent endoscopic sleeve revision 2 years later resulting in 50 lb. weight loss. Five years later, the patient experienced constant acid reflux and gradual weight regain of approximately 40 lb. We proceeded with a second endoscopic re-sleeve for the treatment of weight regain. The endoscopic exam showed evidence of prior sleeve gastrectomy with a markedly enlarged gastric body, intact staple line, and loose endoscopic sutures (Fig 1a). Two parallel anterior and posterior suture placement sites were mapped using coagulation. A tissue screw was used to capture the muscularis propria and an endoscopic suturing device was used to allow for full-thickness bites. A running stich was used to oppose the anterior and posterior placement sites with 2-0 polypropylene sutures (Fig 1b). A cinching device was used to cinch and cut the threaded suture. A total of five sutures were placed in an interrupted sequential pattern with an average of 7 bites per suture to reduce the gastric body volume. No immediate or late complication (Fig 1c). The total procedure duration was 51minutes. The patient tolerated the procedure well and was discharged the same day. The patient lost 20 lb. and 32 lb. at 1 month, and 3-months respectively, corresponding to improvement in body mass index from 35 kg/m 2 pre-procedure to 29 kg/m2 on follow up (Fig 1d). Discussion: LSG and endoscopic sleeve gastroplasty are commonly performed weight loss procedures; however, weight regain remains a limitation. This case emphasizes that endoscopic re-sleeve is a repeatable and feasible option for patients with recurrent weight regain following a revision. Future studies are needed to improve techniques to achieve more durable effects.Figure 1.: (a) Sleeve gastrectomy with prior revision; (b) Endoscopic revision with running stich with overstitch device; (c) Completed endoscopic sleeve revision; (d) Weight loss trend following procedures: A - LSG, B - First endoscopic revision, C- Second endoscopic revision. Laparoscopic sleeve gastrectomy (LSG), Total body weight loss (TBWL).