Post written by Mark Hanscom, MD, from Weill Cornell Medicine, New York, New York, USA.

The focus of our study was exploring the feasibility of a novel intraluminal technique for the treatment of obesity.

Over the last decade, the field of bariatric endoscopy has continued to grow with the introduction of new technologies and refinement of endoscopic techniques. Endoscopic sleeve gastroplasty (Apollo Endosurgery, Austin, Tex, USA) is one such technique that results in proven weight loss through the imbrication and reduction of gastric volume, with mean excess weight loss and total body weight loss of 49% and 14%, respectively.

Although ESG results in proven weight loss, concerns remain about its long-term durability, with a study showing that just 61% of patients maintained total body weight loss of 10% at 5 years.

In response, the gastric antrum has gained interest as a potential novel therapeutic target, with studies revealing that alteration to the antrum could result in changes that impact motor function and lead to enhanced satiety and satiation.

We demonstrate a novel technique that uses a modified gastrostomy tube or intragastric trocar (Endo-TAGSS, Shawnee, Kans, USA) to permit endoluminal access with large-caliber laparoscopic devices, specifically a noncutting stapler.

With rates of obesity rising, more efficacious and durable therapies continue to be needed. Endoscopic techniques for antral reduction through peroral suturing have limitations with regard to long-term durability, as suture dehiscence has been demonstrated as soon as 8 to 14 months postprocedure.

Consequently, endoscopic techniques that more closely mirror surgical outcomes are critical. One potential solution is a combined endoscopic/laparoscopic approach in which endoscopic access permits the use of surgical instruments, such as a laparoscopic stapler, which could result in more durable outcomes.  

We present a novel approach to endoluminal antral gastroplasty using a modified gastrostomy tube and laparoscopic stapler. The procedure was successfully carried out in 2 domestic pigs following approval by the Mayo Clinic Institutional Animal Care and Use Committee and in accordance with the American Physiological Society guidelines for the care of animals.

The laparoscopic stapler was introduced through the trocar and used to place staples along the anterior wall, greater curvature, and posterior wall of the stomach, resulting in imbrication and reduction of the gastric antrum. Postprocedural inspection demonstrated sequential staple lines leading to effective reduction and tubularization of the antrum. There was no evidence of perforation at the staple site or trocar placement and no immediate adverse events.

In the future, such techniques could overcome limitations related to endoscopic technologies by allowing for use of larger-diameter laparoscopic surgical devices in endoscopy, permitting antral gastroplasty in this study. Further studies are needed to refine the technique and explore the weight loss potential, which is anticipated through targeted gastric antral reduction procedures.

The helical endoscopic tissue grasper is used to secure and retract tissue into the jaws of the noncutting stapler before firing to create a full-thickness gastric imbrication.

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