IBC Oxford University Poster Abstract 9 - Laparoscopic sleeve gastrectomy for endoscopic sleeve gastroplasty non-responder

Abstract Background Endoscopic Sleeve Gastroplasty (ESG)is an endoscopic minimally invasive weight loss procedure based on full thickness endoscopic suturing using Apollo’s Overstitch device. In ESG procedure a series of sutures are placed through the gastric wall reducing the stomach volume by 80% creating a restrictive endoscopic sleeve. Case Presentation Our case is a 32-year-old lady with a BMI 35.5 kg/m2 had a history of ESG on 1/2018, presented to our clinic with stationary weight following losing only eight kgs during the first month after the procedure. Following full preoperative assessment including dietary history and psychiatric assessment the patient was counselled for Laparoscopic Sleeve Gastrectomy (LSG). Preoperative gastroscope was done to rule out any gastric inflammations and to confirm that all endoscopic stitches are away from the expected 36 fr bougie tube. LSG was done smoothly using 4 reloads (3 black and 1 green) with staple line plication using vicryl 2/0 sutures and omental patching. Hiatal hernia was repaired with mattress silk sutures, gastric fundus was fixed to left crus with vicryl 2/0 sutures and antrum was fixed to the peripancreatic fascia. All these measures were done to avoid gastric pouch twist or migration. Postoperative recovery was smooth. Weight loss was satisfactory, BMI reached 27.5 at 11 months post LSG. Conclusion ESG can be reversed easily to LSG for procedure non responders.