*3.1.2.1 Technique*

The Overstitch system (**Figure 3**) consists of a double-channel endoscope equipped with a mounted suturing platform. To ensure full-thickness suture placement, a tissue grasper device is used to mobilize and capture the desired location of the suture at the gastric wall, whereafter the tissue is retracted into the suturing arm of the device [20]. As the evolution of the ESG evolved over time, different

**Figure 3.**

*The Overstitch system and full-thickness suture placement (from ApolloEndosurgery®, with permission).*

**41**

**Figure 4.**

*Endoluminal Techniques to Treat Obesity DOI: http://dx.doi.org/10.5772/intechopen.82733*

suture among all stitch points [22].

*3.1.2.2 Efficacy and safety profile*

baseline BMI of 37.8 ± 5.6 kg/m2

take place.

112 obese patients (baseline BMI 37.9 ± 6.7 kg/m2

*3.1.3 Primary obesity surgery endoluminal (POSE)*

to food is more rapidly induced.

techniques of suture placement have been tried, and therefore vary between studies [21]. A recent study showed good effect of a modified running suture following a Z-pattern, to provide a homogenous distribution of the disruptive force on the

After the Mayo Clinic first demonstrated the clinical safety and feasibility of this technique in early 2013, multiple studies have confirmed the safety and efficacy of this procedure. A multicenter study among 3 centers, including 248 subjects with a

[95%CI 14.2–16.3] and 18.6% [15.7–21.5], at, respectively, 6 and 24 month follow-up [23]. Five (2%) serious adverse events occurred: two patients presented with perigastric inflammatory fluid collection which resolved with percutaneous drainage and antibiotics, one patient presented with self-limiting hemorrhage due to marginal splenic laceration, one patient with a pulmonary embolism 72 h postoperative, and one patient required placement of a chest tube to treat concomitant pneumoperitoneum and pneumothorax caused during the procedure. All patients recovered without the need of surgical intervention. A recent retrospective analysis among

Overstitch device reported comparable and consistent findings of approximately 15% TBWL and 50% EWL at 6 month post-ESG [24]. In the prospective study of Sharaiha et al., ESG accounted for a reduction in markers of hypertension, diabetes, and hypertriglyceridemia in addition to sustained total body weight loss after a period of 24 months [25]. ESG appears to be safe and effective in obese patients, but future randomized research is needed before incorporation into clinical practice can

The POSE procedure is an approach in which a reduction of the gastric fundus is created, using a peroral incisionless operating platform (USGI Medical. San Clemente, CA, USA) [26]. During this procedure, transmural plications are placed at eight to nine locations in the gastric fundus with an additional three plications in de distal part of the stomach. The notion behind this is to mechanically and physically restrict the surface to which ingested food comes in contact with the stomach. Moreover, it is assumed that the plications in the gastric fundus limit the capacity to accommodate food, and therefore, activation of gastric stretch receptors in response

*The g-Prox EZ® Endoscopic Grasper (A), transmural plications at the gastric fundus and distal part of the* 

*stomach (B), and stomach after POSE procedure (C) (from USGI Medical®, with permission).*

, showed a total body weight loss (TBWL) of 15.2%

) who underwent ESG using the

techniques of suture placement have been tried, and therefore vary between studies [21]. A recent study showed good effect of a modified running suture following a Z-pattern, to provide a homogenous distribution of the disruptive force on the suture among all stitch points [22].
