LAUSR

Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive treatment option for obesity. In selected patients who are unable to lose weight after ESG, redo ESG can be performed (▶Video 1). A 36-year-old woman with an initial body mass index (BMI) of 42.9 kg/m2 underwent primary ESG in the standard ‘U’ pattern (▶Fig. 1). She tolerated the procedure well; however, she did not reach her intended weight loss goal at 6 months’ follow-up and noted a progressive loss of satiety. Repeat esophagogastroduodenoscopy revealed dehiscence of the sutures (▶Fig. 2). The gastric lumen demonstrated a loss of sleeve-like configuration and the lumen was not restricted. Dehisced sutures were cut and removed using endoscopic scissors and biopsy forceps. Redo ESG was performed using an endoscopic suturing device. A total of eight sutures were again placed in a ‘U’ pattern, with careful avoidance of mucosal bridges and previous suture sites (▶Fig. 3). The gastric wall was less elastic due fibrotic changes from the primary ESG and careful traction was applied when using the tissue helix. Argon plasma coagulation (APC) ablation of the exposed gastric mucosa adjacent to the sutures was performed while avoiding the sutures (▶Fig. 4). APC can induce de-epithelialization and may help promote tissue apposition [1]. The patient tolerated the procedure well and was discharged home the same day. At 6 months’ follow-up, the percentage of total weight loss was 21.2% and her BMI had reduced from 42.9 to 33.5 kg/m2. ESG is a minimally invasive endoscopic bariatric therapy with significant weight loss outcomes. ESG is repeatable, and redo ESG can be a safe option for weight loss in selected patients who desire endoscopic options for revision. Patients who do not achieve weight loss goals E-Videos