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TREATING GERD AND OBESITY A NOVEL APPROACH: SIMULTANEOUS ENDOSCOPIC SLEEVE GASTROPLASTY (ESG) AND TRANSORAL INCISIONLESS FUNDOPLICATION (TIF)
Renan Prado, Arjun Chatterjee, Stephen Firkins, Akash Khurana, Roma Patel, Erika Staneff, Bailey Flora, Rehan Haidry, Roberto Simons-Linares
*Gastroenterology, Cleveland Clinic, Cleveland, OH
Introduction:Obesity and GERD are two prevalent diseases in the US. Endoscopic sleeve gastroplasty (ESG) and transoral incisionless fundoplication (TIF) have been shown to be safe and effective treatment procedures for obesity and GERD respectively. We present a case series of 3 consecutive patients treated with same session ESG + TIF.
Results: Prospective series of three patients (Figure 1) with obesity class I (mean BMI 33.5 kg/m
2) and gastroesophageal reflux disease (GERD) on chronic proton pump inhibitor (PPI) that underwent successful same session endoscopic sleeve gastroplasty (ESG) and transoral incisionless fundoplication (TIF) to treat obesity and GERD. All patient tried multiple lifestyle modifications, and were on long term PPI therapy. After multidisciplinary assessment, we proceeded with same session ESG + TIF in all patients. Baseline characteristics table 1.
After diagnostic upper endoscopy, TIF procedure was performed first using the EsophyX 2.0 device in standard fashion (Endogastric Solutions, Redmond, WA, USA), creating a valve that encompassed 270 degrees of the esophageal circumference, and >3 cm length, as observed in a retroflexed view, secured with esophageal fasteners. Then, the ESG was performed in standard fashion (U pattern) using Overstitch Endoscopic Suture System, double channel endoscope (Boston Scientific, Marlborough, MA)
The morning post procedure, gastrografin esophagram showed no leak and, all patients did well, and patients were discharged home on liquid diet, PPI and prophylactic antibiotics. Mean total body weight loss (%TBWL) at 6 weeks post-procedure was 14.2%, and all patients reported complete resolution of GERD symptoms. There were no immediate serious complications in any of the patients up to 6 weeks follow up.
ConclusionWe present a small cohort of same session ESG+TIF that highlights safety and effectiveness of this approach to treat two very prevalent diseases such as obesity and GERD. More studies with larger sample sizes and longer follow up are needed to investigate this potential combination therapy to treat obesity and GERD.
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