Sleeve gastrectomy remains effective. But if the stomach re-dilates over time, an endoscopic correction is possible — without returning to the operating room.
Sleeve gastrectomy (surgical sleeve resection) is the most commonly performed bariatric procedure in Europe. It consists of surgically removing about 75 to 80% of the stomach, leaving a narrow gastric tube. Initial results are generally excellent.
However, in some patients the remaining portion of the stomach gradually re-dilates over the years. This dilatation leads to increased gastric capacity, reduced satiety and weight regain — sometimes substantial.
Endoscopic sleeve revision (or endoscopic re-plication) is an alternative to surgical re-intervention. Using the OverStitch™ system, Dr. Sitte places internal sutures on the wall of the gastric tube that has become too wide, tightening the lumen and restoring the original restrictive effect — through the mouth, with no abdominal incision.
This technique differs from an ESG performed on a native stomach. The anatomy of a patient who has undergone a sleeve is altered: the remaining stomach is smaller, more tubular, and the wall may present technical particularities. This procedure therefore requires specific experience in advanced interventional endoscopy — beyond simply mastering first-line ESG.
Results depend on the initial degree of dilatation, how long ago the sleeve was performed, and the quality of the associated lifestyle support.
Results vary according to the initial degree of dilatation of the gastric tube and the time elapsed since the sleeve, but remain clinically significant in most cases.
The entire procedure is performed through the mouth using a flexible endoscope — no additional scar, no increased surgical risk.
A surgical revision (conversion to a bypass or re-sleeve) is a complex operation with a far higher surgical risk than the initial procedure. Endoscopic revision offers a markedly more favourable risk/benefit profile.
Sources : Lapointe S et al., Surgical Endoscopy 2023 · Huberty V et al., Endoscopy International Open 2021 · Abu Dayyeh BK, Obesity Surgery 2022
Endoscopic sleeve revision is intended for patients who:
Have undergone a sleeve gastrectomy and observe a gradual weight regain, most often several years after the initial procedure.
Have a dilatation of the gastric tube documented by endoscopy or imaging — an essential criterion to be confirmed in consultation.
Wish to avoid re-operation — in particular a surgical conversion to a bypass, a more invasive procedure with a significantly longer recovery.
Have no endoscopic contraindication — technical eligibility is assessed case by case during a preliminary work-up with Dr. Sitte.
"Regaining weight after a surgical sleeve is not a definitive failure. It is a recognised medical situation for which an endoscopic solution exists — without returning to the operating room."
Eligibility for this technique is assessed during an in-depth consultation with Dr. Sitte.
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