Post written by Theodore W. James, MD, from the Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina.

We demonstrated that not only does the gastric body shorten during endoscopic sleeve gastroplasty, but the gastric fundus descends as well. This often brings the fundus below the GE junction and increases the risk for transfundic suture placement.

Suture placement through the fundus increases the risk of perigastric fluid collections and abscess formation that will lead to less favorable clinical outcomes. Before beginning an endoscopic sleeve gastroplasty, the endoscopist should clearly mark the fundic boundaries with APC. This will allow for safer suture placement.

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