Since its first description in 2013, robust evidence supporting the efficacy and safety of the endoscopic sleeve gastroplasty (ESG) has been on the rise. A large case series and meta-analysis report supported results up to 24 months, while some other studies already described 5-year data. If associated with pharmacotherapy, the ESG may help one to achieve weight loss similar to that of surgical sleeve gastrectomy. Though the results of the ongoing randomized trials on ESG are awaited, currently available data support the clinical use of the ESG, especially for patients who are refusing or unfit for bariatric surgery.
Gastrectomy ; Gastroplasty/methods* ; Humans ; Laparoscopy ; Obesity, Morbid ; Treatment Outcome

Bariatric surgery is an effective way to achieve long-term weight reduction in severely obese patients. This article illuminates the indications, procedures, complications, and results of bariatric surgery for severe obesity.
Bariatric Surgery ; methods ; Gastric Bypass ; methods ; Gastroplasty ; methods ; Humans ; Obesity, Morbid ; surgery

Digestive System Surgical Procedures ; methods ; Gastroplasty ; methods ; Humans ; Minimally Invasive Surgical Procedures

Aged ; Anastomosis, Surgical ; Esophageal Neoplasms ; surgery ; Female ; Gastroplasty ; methods ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Male ; Middle Aged

PURPOSE: Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications. MATERIALS AND METHODS: The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications. RESULTS: From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period. CONCLUSION: The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.
Adult ; Female ; Gastroplasty/adverse effects/*methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity, Morbid/*surgery ; Postoperative Complications ; Treatment Outcome

Obesity is a complex metabolic disease. Currently, obesity treatment includes lifestyle modification, obesity drug treatment, and bariatric surgery. Lifestyle modification is an essential part of obesity treatment, but it is limited by itself. And anti-obesity treatment drugs also showed limited weight loss effect, about 3-9% per year, and can cause serious side effects such as cardiovascular side events. Surgical treatment requires high cost, permanent resection of the gastrointestinal tract and can cause complication related to surgery. Recently, several promising endoscopic bariatric therapies are emerging. Endoluminal bariatric treatment using flexible gastrointestinal endoscopy could offer a minimally invasive treatment aimed at achieving an effect comparable to obesity surgery, while offering advantages of low cost and safety. In this paper, we described a new technological method, recent clinical data, and the latest findings on obstacles to be overcome for endoscopic gastroplasty using endoscopic suture instruments. Endoscopic gastroplasty presented reduced gastric volume, effective weight loss and maintenance effect without severe adverse events. It could suggest an attractive treatment option for obesity.
Bariatric Surgery ; Bariatrics ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrointestinal Tract ; Gastroplasty* ; Life Style ; Metabolic Diseases ; Methods ; Obesity* ; Sutures ; Weight Loss

OBJECTIVETo compare the immunity of morbid obesity (MO) before and after laparoscopic adjustable gastric banding (LAGB).

METHODS15 cases, with a mean body mass index (BMI) of 35.8 kg/m(2), were treated by LAGB from Jun. 2003 to Oct. 2003 in our department. Patients' immune parameters were determined preoperatively and 1, 3 and 6 months postoperatively. 15 cases with a normal BMI (23.6 kg/m(2)) were set as controls.

RESULTSBefore surgery, the MO had a significant lower level of CD(4)(+), CD(4)(+)/CD(8)(+) and a higher level of serum interleukin-2 (IL-2), Interleukin-6 (IL-6) than the controls (P < 0.01). There was a significant reduction of weight and BMI 6 months postoperatively (P < 0.01). At the same time, CD(4)(+) increased and serum IL-2 decreased significantly. But CD(4)(+)/CD(8)(+)and serum IL-2, IL-6 were still abnormal compare to the controls.

CONCLUSIONSMO may combined with an abnormal immunity. But after enough weight loss induced by LAGB, it can be partly reversed.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Gastroplasty ; methods ; Humans ; Laparoscopy ; Male ; Obesity, Morbid ; immunology ; surgery ; Weight Loss

Esophageal perforation after endoscopic forceful pneumatic dilatation for achalasia is a devastating complication and surgical treatment is necessary. A 65-yr-old man and a 54-yr-old woman referred for esophageal perforation two hours after pneumatic dilatation and during the procedure, respectively. Gastroplasties through thoracotomy were performed in both cases and their recoveries were uneventful. The esophagogram with gastrografin on the post-operative 8th day did not show any passage disturbance or leakage at the anastomosis site. On the follow-up endoscopy 4 to 6 months after operation revealed that reflux esophagitis of LA classification A were noted in the both patients. They did not complain any reflux symptom or dysphagia for 9 to 13 months after operation. Instead of the most widely used procedure; primary repair of perforation site, wrapping with intercostal muscle flap and esophagomyotomy, gastroplasty was performed in two cases of iatrogenic esophageal perforation in achalasia and experienced good results.
Aged ; Deglutition Disorders/complications ; Endoscopy, Gastrointestinal/*adverse effects ; Esophageal Achalasia/*surgery ; Esophageal Perforation/*surgery ; Esophagus/*surgery ; Female ; Gastroesophageal Reflux/complications ; Gastroplasty/*methods ; Humans ; Male ; Middle Aged ; Thoracotomy

OBJECTIVETo investigate the diagnosis and treatment of the complications in patients after laparoscopic adjustable gastric banding (LAGB) procedure.

METHODSRetrospectively analyze the data of the 23 patients who received the LAGB procedure from June 2003 to November 2004.

RESULTSOf the 23 LAGB operations, 3 (13%) cases of vomiting and nausea, 1 (4.3%) case of access-port infection and 5 (21.4%) cases of food intolerance occurred. One band (4.3%) and one injection reservoir (4.3%) displaced and were removed by laparoscopy. No death and thrombo-embolism occurred.

CONCLUSIONSThe diagnosis and treatment of complications after LAGB in morbid obesity was special, if managed properly, the result would be satisfactory.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Gastroplasty ; adverse effects ; methods ; Humans ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Obesity, Morbid ; surgery ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Retrospective Studies

OBJECTIVETo assess the safety and feasibility of laparoscopic adjustable gastric banding (LAGB) and a multi-disciplinary team (MDT) approach in the treatment of morbid obesity and its complications.

METHODSWe retrospectively analyzed the clinical data of 16 patients who underwent LAGB and MDT approach in Peking Union Medical College Hospital from October 2009 to February 2011.

RESULTSOf these 16 patients, 15 patients completed the 3 month follow up; their body weight and body mass index (BMI) decreased significantly after treatment (both P=0.000), with an percentage of excess weight loss (%EWL) of (25.7±7.4)%. Thirteen patients completed 6 month follow up; their body weight and BMI were significantly lower than the preoperative levels (both P=0.001), while there were no significant difference between the third and sixth month measurements (P=0.103 and P=0.053, respectively); %EWL of 6 months after operation was significantly higher than that of 3 months after operation [(37.0±14.7)% vs. (29.1±6.8)%,P=0.042]. Six patients completed 12 month follow up; their body weight and BMI decreased significantly at the first 3 months after operation (P=0.007 and P=0.005,respectively) and at the second 6 postoperative months (P=0.007 and P=0.013,respectively); the BMI of 6 months after operation was significantly lower than that of 3 months after operation (P=0.045), but there was no significant difference of body weight between the third and sixth month after operation (P=0.065); meanwhile, the %EWL increased significantly within the second 3 postoperative months from (29.6±6.8é% to(42.4±14.0é%(P=0.028), and also within the second 6 postoperative months (60.4±12.6é%(P=0.001). In 9 patients with pre-operative obstructive sleep apnea hypopnea syndrome, the symptom was remarkably resolved in all these 9 patients 3 months after the treatment. Of 16 patients with preoperative metabolic syndrome, the condition was obviously improved after treatment in 10 patients. Of 9 patients with hypertension preoperatively, the blood pressure returned to normal level after the withdrawal of antihypertensive agents in 7 patients; in addition, one patient had his dose decreased and one patient switched to a milder antihypertensive agent. Of 8 patients accompanied with type 2 diabetes, 7 had their antidiabetic drugs withdrawn after the blood sugar returned normal and one patient had his dose decreased.

CONCLUSIONLAGB combined with MDT approach is effective, safe, and feasible for treating morbid obesity and its complications.

Adult ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Gastroplasty ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity, Morbid ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult