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A sleeve within a sleeve

  • A sleeve within a sleeve Figure 1

Question

A 57-year-old woman with obesity class III (body mass index: 42 kg/m2) and a history of open cholecystectomy secondary to gangrenous cholecystitis presents for weight regain of 25 kg from nadir weight loss after surgical sleeve gastrectomy 7 years ago. An upper GI series demonstrates gastric sleeve dilation. Given her poor surgical candidacy, she is offered endoscopic sleeve gastroplasty (ESG) with argon plasma coagulation-reinforced suturing (Figure). Which of the following is true about primary ESG for weight loss?

The entire stomach is imbricated, so that the fundus and antrum are significantly restricted in size. The dissemination of ESG is hampered by increasing rates of gastroesophageal reflux disease compared with laparoscopic sleeve gastrectomy. ESG with lifestyle modifications is an U.S. Food and Drug Administration (FDA)-approved intervention for primary therapy of obesity classes 1 and 2. The long-term weight-loss durability of ESG has been firmly established.
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