Is ESV Indicated for VSG Revision?

Pamela from Houston sent us a question inquiring about the use of ESV or endoscopic sleeve gastroplasty as revision surgery for weight regain after VSG or sleeve gastrectomy. To start, ESV is a poor primary weight loss procedure. ESV is a purely restrictive procedure that does not alter stomach and intestinal hormones that control food intake, appetite, and satiety as well as insulin resistance. VSG on the other hand, is a metabolic procedure that alters gastrointestinal hormone secretion in response to food intake to favor weight loss. Contrary to popular belief, weight regain after VSG is not secondary to gastric sleeve stretching. Rather, weight regain after VSG occurs because of loss of these gastro-intestinal hormones that favor weight loss. Hormones like GLP_1 and PYY increase after VSG leading to decreased insulin resistance, increased satiety, decreased appetite… When VSG patients return to old unhealthy eating habits, they damage the same hormones that helped them lose weight initially. Slowly, they start overeating and gaining weight. In the process, the sleeve lumen stretches. Hence, the increase in sleeve size is a consequence rather than a cause of weight regain.

Therefore, reducing the stretched gastric sleeve size, endoscopically via ESV, or laparoscopically via redo VSG, is not associated with significant weight loss. At Houston Weight loss Surgery Center, we do not recommend Endo-sleeve, or re-sleeve, for weight regain after sleeve gastrectomy.