Endoscopic sleeve gastroplasty: live interactive case

Bariatric surgery is considered to be the most effective and durable treatment for morbid obesity as compared to other available options. However, only the most severe cases, namely class III or class II patients with obesity-related comorbidities fit the criteria for bariatric surgical interventions and are offered these options. Additionally, patient acceptance of surgical therapy remains low with the result that only a small percentage of eligible patients finally undergo surgery. Endoscopic bariatric therapies are inherently less invasive, safer, and less expensive, and offer a minimally invasive alternative to those patients who do not meet the operability criteria or refuse conventional surgery. Endoscopic sleeve gastroplasty (ESG) is a promising endoscopic bariatric procedure based on the tubulization and shortening of the stomach, achieved by means of multiple full-thickness permanent 2/0 polypropylene sutures applied endoscopically using an over the endoscope suturing platform (OverStitch, Apollo Endosurgery, Austin, Texas, USA). As opposed to laparoscopic sleeve gastrectomy (LSG), in which a large part of the stomach is surgically removed, ESG is a potentially reversible and repeatable organ-sparing procedure. This video illustrates a full ESG live procedure providing a point by point description of the essential technical points.