Endoscopic sleeve gastroplasty using Apollo Overstitch as a bridging procedure for superobese and high risk patients.

In some cases, bariatric procedures cannot be performed via laparoscopic or open surgery because of surgical contraindications or high operative risk. Endoscopic sleeve gastroplasty (ESG) using an Overstitch (Apollo Endosurgery, Austin, Texas, USA) is a recently described procedure [1, 2] with good preliminary 1-year results in small series and low complication rates [3–5] for patients with a body mass index (BMI) ranging from 30–45 kg/m2. However, the routine use of ESG for superobese and high risk patients has not yet been described. The indications for ESGs performed in five superobese patients in our institution were as follows: (i) surgically impenetrable abdomen due to multiple operations or a giant incisional hernia; (ii) future liver or kidney transplant recipient; (iii) high risk patient with a contraindication to operation; (iv) a bridging procedure in a two-step concept (the first endoscopic, the second surgical 12–18 months later). Patients with BMI ranging from 51–72 kg/m2 with numerous co-morbidities were submitted to ESG after multidisciplinary evaluation. With the patient under general anesthesia and after installation of an overtube (Apollo Endosurgery), ESG was perE-Videos