Endoscopic stitching used to be limited to patients whose bariatric surgery needed a boost. Today, Johns Hopkins gastroenterologists are using new procedures in endoscopic stitching to replace surgery.

When results of Roux-en-Y bariatric surgery deteriorated, says gastroenterologist Mouen Khashab, the endoscope frequently was the next step.

Whether the patient’s stoma opening had widened or whether the stomach pouch itself had stretched, Khashab says the fix was endoscopic.

“When the stoma gastric outlet becomes enlarged, the early satiety that’s induced by the Roux-en-Y procedure is gone and patients can regain weight,” says Khashab. “Sometimes the opening gets as big as 30 or 40 millimeters. We can use the stitch device to get that back down to 8, where it’s been associated with weight loss.”

Similarly, endoscopic stitching has been the go-to procedure for patients whose stomach pouches have stretched to sizes nearly as large as their presurgery stomachs.

“The stomach can distend over time,” says Khashab, “and the early satiety that the surgery caused is lost.”

Khashab says a simple stitching can restore the benefits of bariatric surgery.

But he adds that there is increasing interest in a similar endoscopic procedure that would replace the surgical sleeve gastrectomy, which, in the past few years, replaced the Roux-en-Y as the most common bariatric surgery.

“In the past few years, there has been a movement to try something similar, only using the stitching device on the endoscope rather than surgery. We’re trying to mirror the surgical sleeve gastrectomy,” says Khashab.

“Basically, we create a gastric sleeve, which causes reduction in gastric volume and induces weight loss.”

Khashab says improvements in the technique have made the procedure even more promising.

“It’s more effective and more durable,” he says. “Endoscopic stitching to create a gastric sleeve takes between 60 and 90 minutes and is associated with about 30 percent of excess weight loss.

“It’s done in the endoscopy unit using standard equipment.”

Patients are typically kept overnight to treat mild pain and nausea.