Revisional Surgery: Sleeve to Endosleeve

Weight loss trajectories after laparoscopic sleeve gastrectomy (LSG) vary between patients. Like all bariatric surgeries, some patients eventually end up requiring revision to another procedure for reasons including insufficient weight loss or weight regain, and procedure-related adverse events. Approximately 10% of patients who undergo LSG require revision, which can be observed 18 to 24 months post-LSG. Currently, there is growing interest in endoscopic revision of LSG as a minimally invasive, incisionless alternative to classical surgical revision. In this chapter, we review the assessment of patients who present with weight recidivism. Additionally, we discuss the role of revisional endoscopic sleeve gastroplasty (rEGP), an endoscopic gastric plication technique that utilizes full-thickness sutures. We describe our technique and follow-up protocol, and review outcomes associated with endoscopic revision.