Introduction Obesity is an increasing health problem worldwide. Roux-en-Y gastric bypass can produce a 56%–66% wt loss 2 years after surgery. Roughly 20% of patients fail to achieve 50% wt loss in the 1 st year after gastric bypass. Furthermore, 30% of patients regain weight 18 to 24 months after bypass. Revision surgery can be very challenging with higher complication and mortality rates than that of primary gastric bypass.

Endoscopic therapy has the potential to be a suitable alternative in this patient set. The overstitch endoscopic suturing system (Apollo Endosurgery, Austin, Texas) is a disposable, single-use, in vivo reloadable device that is mounted onto a double channel gastroscope that enables suture application.

Method We present a video and discuss the technical details of roux-en-y gastric bypass revision using the Apollo OverStitch. The procedure steps include (video): 1. OverStitch Endoscopic Suturing System Overview 2. Argon Plasma Coagulation (APC) application to the margins of the gastrojejunal anastomosis 3. Placement of sutures using the OverStitch system.

Results A 28 year old female, 2 years after Roux-en-Y gastric bypass presented with increasing weight gain to 190 kg. Past medical history includes mild depression and moderate anxiety. A diagnostic OGD showed a very patent gastrojejunostomy anastomosis, measuring approximately 20 mm across. Endoscopic revision of the bypass anastomosis was performed using the Apollo OverStitch to encourage weight loss.

The procedure was performed under a general anaesthesia, and involved the placement of an overtube. APC using a straight firing catheter at 1 litre/min (40 watts) was applied to the margin of the gastrojejunal anastomosis. 6 sutures were placed using the EndoStitch system to approximate the interior borders of the anastomosis with good results. There were no immediate complications. 8 months after placement of Apollo OverStitch, weight remained at 179 kg.

Conclusion In one study of 25 patients where the OverStitch was used for revision of gastric bypass, patients lost an average of 11.7 kg at 6 months. Our case highlighed similar weight loss of 11 kg at 8 months.

References

1. . http://apolloendo.com/overstitch/

2. . Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration. Nitin Kumar. World Journal of Gastroenterology. Jul’15.

3. . Jirapinyo P, Slattery. J, et al. Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Endoscopy2013; 45:532–536.

Disclosure of Interest None Declared