Dr. Ahmed
The Apollo Overstitch endoscopic suturing system is not a procedure but a method of suturing the gut via an endoscope.
It is commonly used to treat gastrointestinal perforations and leakage because of its non-invasive nature.
The Apollo overstitch procedure is also used to treat morbid obesity. It is somewhat similar to a gastric sleeve but is less invasive and less effective when used as a primary procedure for weight loss.
More commonly the Apollo overstitch procedure is used after gastric bypass when after some years the anastomotic pouch starts to distend and weight regain is noted.
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What is Apollo Overstitch Procedure?
Most patients who undergo bariatric surgery need revision after some time because of weight regain. The weight loss period after bariatric surgery usually lasts for two to five years.
After five years, patients either stop losing weight or start gaining weight. In the first 2 years, the Roux-en-Y gastric bypass procedure is associated with 50-66% of the excess body weight loss.
However, about 20% of patients fail to show desirable effects. Some of these patients opt for revision surgery.
One of the best non-invasive methods is the Apollo overstitch procedure. Apollo overstitch is a minimally invasive procedure done via an endoscopic approach.
Apollo overstitch is a system that is designed for revision of Roux-en-y gastric bypass after weight regain. Compared to other revision procedures, it is associated with the least complications.
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How is the Apollo Overstitch Procedure Performed?
The Apollo overstitch procedure can be performed as a primary weight loss procedure or it can be used after gastric bypass to minimize weight regain.
When used as a primary weight loss procedure, it is called endoscopic gastroplasty.
The principle of endoscopic gastroplasty via the Apollo overstitch endosurgery is to reduce the stomach volume by stitching the walls of the stomach together.
Like gastric sleeve surgery, endoscopic gastroplasty reduces the stomach volume and hence less food can be accommodated. This results in weight loss.
The Apollo overstitch is specially designed for patients who have had gastric bypass surgery. As with time, the anastomosis between the stomach pouch & small gut widens leading to weight regain over time.
Most of these patients who desire to lose more weight and avoid weight regain, opt for gastric bypass revision surgery or the Apollo overstitch procedure.
For patients who opt for the Apollo overstitch procedure, an endoscope is passed into the stomach and the full-thickness sutures are applied to narrow the anastomosis lumen.
Thus, the stomach can not accommodate more food resulting in weight loss.
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Apollo Overstitch Weight Loss Results:
The Apollo overstitch procedure has been associated with a weight loss of about 11 kgs (24 pounds) over a period of six months.
Although comparative studies need to be performed to determine its efficacy, 11 kgs of weight loss over six months is significant.
It is more effective than most weight loss pills, other endoscopic procedures such as a gastric balloon, and the Aspire Assist system.
However, it is less effective than gastric sleeve and gastric bypass surgeries. In fact, it is more commonly used as a revision to gastric bypass than as a primary procedure for weight loss.
This provides the patient with long-term control over weight loss. Because of its durability & simplicity, it is preferred in patients with gastric bypass.
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Who Can Opt for the Apollo Overstitch Procedure?
This procedure is designed for patients who have undergone gastric bypass and now have regained weight.
If your weight regain is due to the dilatation of the gastro-jejunostomy anastomosis pouch, then you are a candidate for the Appollo overstitch system.
In addition, more obese patients now opt for primary endoscopic gastroplasty. However, as a primary procedure, it may not be as effective as gastric bypass surgery or gastric sleeve surgery.
Who should not undergo the Apollo overstitch procedure?
There are no contraindications specific to this system. However, patients who have any contraindication to esophago-gastro-duodonoscopy are not candidates for this procedure.
Common contraindications include:
- Esophageal structure or tumor.
- Bleeding gastric ulcer (marginal ulcer this is commonly associated with bypass)
- Gastric tumor.
- Esophageal motility disorder
- Para esophageal Hernia
- Connective tissue disorder
- Severe Hepatic insufficiency
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What are the complications of the Apollo overstitch procedure?
Most of the complications that are associated with the system are those which arise as a result of Upper GI endoscopy or stitching of the anastomotic lumen.
These include:
- Pharyngitis
- Sore throat
- Bleeding
- Nausea
- Vomiting
- GERD
- Esophageal or gastric perforation.
