Laparoscopic Roux-En-Y gastric bypass, although less invasive than the open technique is still associated with morbidity and mortality rates which although reduced are not negligible. Less invasive procedures for morbid obesity would greatly benefit such high-risk patients. This video demonstrates a novel endoscopic gastric bypass as treatment for obesity.

A 39 year old female with a BMI of 40.5 kg/m² and no past medical history was enrolled under IRB protocol to undergo an endoscopic bypass using the ValenTx endoscopic sleeve (ValenTx Inc., Carpinteria, CA). An initial overtube is inserted endoscopically past the pylorus, followed by deployment of the sleeve through the proximal small intestine. The proximal sleeve is released temporarily into the stomach. The gastroesophageal junction is then completely mobilized laparoscopically. Using the assistance of laparoscopic visualization, the proximal portion of the endoscopic sleeve is fixed with transmural anchors circumferentially. Following fixation of the sleeve, the crura is reapproximated with interrupted suture and the gastric fixation sites reinforced with biological glue.

Postoperative contrast swallow examination showed no leak from the fixation sites. The sleeve was in proper position and demonstrated free flow through the end of the sleeve. At four weeks time, the patient demonstrated 20.8% excess weight loss, with her BMI decreased to 37.3 kg/m².

Endoscopic treatment for morbid obesity using the sleeve described shows promising initial results in achieving weight loss. Long-term followup and will allow comparison of outcomes with standard bariatric procedures in practice today.