endoscopic sleeve gastroplasty

Conditions: Morbid Obesity

Summary: the endoscopic sleeve gastroplasty allows stomach size reduction through an endoluminal suture approach without any incision. it could reduce the complications associated with current surgical techniques while obtaining the target gastric restriction, weight loss, comorbidities and quality of life improvement. the primary objective of this study is to assess weight loss after endoscopic sleeve gastroplasty in patients with morbid obesity.

gastric restriction is one of the fundamental principles of gastric bypass and gastric banding. nowadays, practitioners have the possibility to reduce stomach size by merging tissues through an endoscopic endoluminal suture approach without any incision. this could reduce the complications associated with current surgical techniques while obtaining the target gastric restriction, weight loss, comorbidities and quality of life improvement. the primary objective of this study is to assess weight loss after endoscopic sleeve gastroplasty in patients with morbid obesity according to the technique described in the literature: reduction of the gastric pouch into a sleeve structure by modification of the stomach greater curvature thanks to a plication.

Eligibility criteria:
inclusion criteria: * patient \> 18 years old and \< 60 years old * patient with morbid obesity for at least 2 years * patient who failed medical and diet treatment of obesity * patient with no contraindication to anesthesia * patient able to understand the study and to provide informed consent. exclusion criteria: * patient with inflammatory, tumoral or bad quality tissues at endoscopy * patient with a history of gastro-intestinal inflammatory disease, stenosis or intestinal adhesions, kidney or liver failure, chronic pancreatic disease * patient with a history and/or signs and/or symptoms of gastroduodenal ulcerous disease and/or progressive gastroduodenal ulcerous disease * patient with an oesophageal pathology as zenker's diverticulum, peptic oesophagitis stage 3-4, oesophageal stenosis, barrett syndrome, oesophageal cancer, dysphagia, achalasia * patient with previous bariatric, gastric or oesophageal surgery, intestinal obstruction, portal hypertension, gastro-intestinal tumors, oesophageal or gastric varices, gastroparesis * patient with a severe coagulopathy (prothrombin time \> 3 seconds or thrombocytic count \< 50 000/mm3) or treated with heparin, coumadin, warfarin or any other anticoagulants and drugs preventing coagulation or platelet aggregation, except aspirin and nonsteroidal anti-inflammatory drugs * pregnancy, breastfeeding or woman without contraception * patient with a congestive heart failure, arrhythmia or unstable coronary heart disease * patient using or having used diet drugs within the last 30 days or intending to use them during study follow-up * patient under drug treatment within the last 3 months known to induce weight gain * patient with eating disorders or uncontrolled, poorly controlled or suspected psychiatric disease * patient in a poor condition according to investigator * patient in exclusion period (determined by a previous study or in progress) * patient with significative weight loss between date of enrollment in the study and date of procedure * patient with a systemic infection the day of procedure.

Keywords: endoscopic sleeve gastroplasty excess weight loss quality of life