Novel Endoscopic Resection Suturing Technique for the Treatment of Obesity

Study data published in Gastroenterology support the efficacy and safety of a novel endoscopic mucosal resection (EMR) technique for use during bariatric surgeries.

The osculating circles gastroplasty (OCG) technique can be used during both endoscopic sleeve gastroplasty (ESG) and tubular transoral outlet reduction (TORe) procedures; it is intended to maximize procedure durability without compromising simplicity.

Currently, both ESG and TORe use full-thickness endoscopic sutures which “primarily appose mucosal surfaces,” thus relying on suture integrity to maintain the gastroplasty. The OCG technique instead introduces submucosal wounds “with apposition of these [mucosal] surfaces” by endoscopic suturing. By engaging submucosal surfaces, OCG is theorized to better activate the healing cascade of the gastrointestinal tract, promoting more rapid reepithelization and collagen formation.

To test the efficacy of this novel technique, investigators enrolled 14 patients undergoing either ESG or tubular TORe for weight management. All patients were women, and mean age was 47.4±10.7 years. The primary outcome was technical feasibility and safety. The OCG technique was employed for each procedure, utilizing EMR with band-ligation and endoscopic suturing.

The incorporation of the OCG technique added an average of 12±8 minutes to total procedure time. The technique was well-tolerated by patients and resulted in “excellent” gastroplasty formations in all cases.

Repeat endoscopy was performed in 3 patients for nausea or abdominal pain. In these 3 patients, the endoscopy revealed a “robust” healing cascade with “enhanced fusion” of the approximated surfaces compared with full-thickness suturing. While follow-up time was short, most patients displayed increased weight loss compared with standard ESG or TORe.

Results from this preliminary report support the potential for OCG to refine and enhance endoscopic therapy outcomes. Further study is necessary to confirm its safety and long-term impact.

“We believe that this simple novel addition to both techniques can be transformative to the field of bariatric and metabolic endoscopy and potentially offer robust and durable outcomes superseding current standards, without excessive negative impact on procedural safety, efficacy, or cost,” investigators wrote.

Disclosure: Two study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Mahmoud T, Vargas EJ, Ghazi R, Abusaleh R, Storm AC, Abu Dayyeh BK. The osculating circles gastroplasty: a novel endoscopic submucosal resection enhanced endoluminal suturing for obesity. Gastroenterol. 2021;161(6):1806-1808. doi: 10.1053/j.gastro.2021.08.059

This article originally appeared on Gastroenterology Advisor