Post written by Andrew Canakis, DO, from the Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.

A young woman who had undergone endoscopic sleeve gastroplasty (ESG) was referred due to persistent symptoms of delayed gastric emptying and resulting malnutrition. Endoscopic reversal of the sleeve was recommended to avoid a more invasive surgery.

Division of a thick-tissue bridge in the body of the stomach was accomplished by scissor-type knife dissection and resulting mucosal defect closures (clips and X-Tack) to prevent bleeding or reforming of the bridge. Two months later, she remained asymptomatic with improved nutritional parameters.   

ESG is an increasingly utilized weight loss tool. Yet, reversibility after various stages of healing of the sleeve is not well-described. In this video, we report a technique for successful reversal with symptom resolution by dissecting a symptomatic tissue bridge 2 years after ESG.

Endoscopists should remain cautious that full-thickness injury, including perforation, may complicate ESG reversal, and we recommend having appropriate tools and experience on-hand.

Tissue bridge in the distal body of the stomach causing intractable symptoms 2 years after endoscopic sleeve gastroplasty.

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