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Background
Over the last decade, several techniques have emerged and the bariatric trends have changed. A new bariatric procedure that has been proposed is laparoscopic vertical clip gastroplasty (LVCG), which mimics the principle of laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. The introduction of a new procedure in...
Context in source publication
Context 1
... clip consists of a silicone-covered titanium backbone with an inferior hinged opening that separates a medial lumen from an excluded lateral gastric pouch. The inferior opening allows the gastric juices to empty from the fundus and the body of the stomach into the distal antrum ( Fig. 2 ). The technique thus did not involve extensive dissection of the hiatus. ...
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Introduction
Endoscopic sleeve gastroplasty (ESG) is a novel endoscopic bariatric therapy that complements current medical and surgical therapeutic offerings for weight management and fills an unmet need. Few meta-analyses compared ESG to laparoscopic sleeve gastrectomy (LSG). However, these studies relied on indirect evidence derived from non-comp...
Citations
... The initial complications reported were erosion with an incidence of 1.4%, slippage of 6.52%, gastroesophageal reflux of 5% in the first month, and a decrease of 0.72% after the second month [2]. This study aims to report the experience of 3 years of a single bariatric surgical group, report 3 clinical cases of complications 1 from this group and 2 from a nonbariatric group, and do a literature review and a proposal for a definitive standardization of the technique. ...
... Jacobs et al. described a weight loss of up to 60% over 5 years and reported the following complications [3]: clip slippage, which occurred in 6-7.7% of cases, and erosions with an incidence of 1.4-2.6% [2,3]. ...
... The plan is to tackle these cases in two phases, with the first involving clip extraction from the gastric wall and the second involving a definitive derivative procedure. Authors have emphasized the significance of removing the BariClip in cases of complications such as intolerance, erosion, slippage, unsuccessful repositioning, and gastric obstructions [1][2][3][4][5][6][7]. In our experience, we have also removed clips for similar reasons. ...
Laparoscopic vertical clip gastroplasty (LVCG) with BariClip is a recent procedure that appears to be safe Gentileschi et al. (Obes Surg 33(1):303-12, 2023). The initial complications reported include erosion, slippage, and gastroesophageal reflux. This study aimed to report on the experience of a single surgical group, analyzing three clinical cases, conducting a literature review, and proposing a standardization of the technique. A retrospective study was conducted with data from June 2021 to October 2024. We collected the data from the procedures related to the bariatric clip made by only one surgical group; we collected 69 cases with 1 complication of this surgical group. Additionally, we described 2 clinical cases of complications related to bariatric clips from other surgical institutions and reviewed the literature related to the BariClip experience. The results are related to the evaluation of the technique and compare the different modifications implemented over the last 3 years of follow-up. Furthermore, we aim to share our experience in attending to one of the most concerning complications associated with this procedure. The LVCG is a safe procedure with a low incidence of complications and positive results in %EWL. We propose several modifications to the original technique to further reduce complications, and we share the experience of both treating and resolving some of the complications we encountered.
... In literature, slippage of BariClip is reported as the main complication related to this surgery (6.0-7.7%) [12,13]. Jacobs et al. in a 39-month pilot study found a slippage rate of 7.7%, while Noel et al. and Gentileschi et al. found a similar slippage rate of 6-6.5%. ...
... Jacobs et al. in a 39-month pilot study found a slippage rate of 7.7%, while Noel et al. and Gentileschi et al. found a similar slippage rate of 6-6.5%. These rates are reported to decrease after the learning curve by these authors [12,13]. ...
Background
Laparoscopic BariClip gastroplasty (LBCG) is a new reversible bariatric procedure designed to replicate the restrictive effects of laparoscopic sleeve gastrectomy (LSG) by placing a clip vertically on the stomach. This technique achieves gastric lumen restriction without the need for resection, ensuring organ preservation and reversibility. However, concerns have arisen regarding potential complications such as gastroesophageal reflux disease (GERD), slippage, or erosion of the stomach. The aim of the study is to evaluate the outcomes and complications of LBCG.
Methods
This is a monocentric retrospective study. We analyzed 149 patients who underwent LBCG procedure between July 2021 and November 2023. A minimum follow-up period of 6 months was observed for all patients, recording clinically relevant GERD through GERD-Q score questionnaires. Weight loss was monitored through body mass index (BMI) and % total weight loss (%TWL), registered during follow-up visits.
Results
Overall, 149 patients were eligible for this study. Overall complication rate was 8% (12/149). The average BMI went from 40 ± 4.37 kg/m² to 28 ± 4.29 kg/m² (p < 0.05) in 6 months, while the mean %TWL was 22.6% after at least 6 months of follow-up. Clinically relevant GERD went from 18.1% (27/149) to 10.7% (16/149), p = 0.1262. As expected, also the PPI usage was not altered significantly (17.8% vs 16.4%), p = 0.8714.
Conclusions
LBCG remains an experimental procedure that must be approached with caution. Nonetheless, the potential of LBCG to reproduce the effects of LSG while reducing GERD makes it a promising new reversible option for the treatment of morbid obesity.
... The laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy that involves a vertical clip placed parallel to the lesser curvature of the stomach. The first short-term clinical results published have already shown comparable weight loss results to LSG with very few complications and good quality of life for patients [4,5]. Laparoscopic BariClip gastroplasty (LBCG), like other gastric procedures [6,7] using a peri gastric foreign body, can be complicated with slippages. ...
... The BC is made of a titanium skeleton covered with silicone and fixed anteriorly and posteriorly to the stomach silicone with an inferior opening allowing the passage of the gastric juices from the fundus and the body of the stomach into the distal antrum. The BC is placed vertically parallel to the lesser curvature at the same level where a sleeve gastrectomy is usually performed preserving the antrum [4,5]. ...
Introduction
Laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy proposed to minimize the risk of severe complications. Still one of the possible complications described with LBCG is slippage. The purpose of the current manuscript is to analyze different cases of slippage and propose a classification of this complication.
Methods
A number of 381 patients who underwent LBCG in 8 different centers were analyzed concerning the risk of slippage. All cases with documented slippage were carefully reviewed in terms of patients’ symptomatology (presence of satiety, vomiting), history of weight loss, radiological data, and management of their slippage. A new classification was proposed depending on the anatomy, the symptomatology, and the time of occurrence.
Results
We have identified a total of 17 cases (4.46%) of slippage following LBCG. In 11 patients, the slippage was symptomatic with repetitive vomiting and nausea, and in the remaining 6 patients, the slippage was identified by radiological studies for insufficient weight loss, weight regain, or routine radiological follow-up. Depending on the interval time, the slippage was classified as either immediate (in first 7 days) in 6 cases, early (in less than 90 days) in 4 cases, and late (after 3 months) in 7 cases. Evaluation of the radiological studies in these cases identified the following: anterosuperior displacement (type A) in 9 cases, posteroinferior displacement (type B) in 6 cases (one case after 3 months), and lateral displacement (type C) in the remaining 2 cases. The management of the slippage consisted of BariClip removal in 7 cases, repositioning in 5 cases, and conservative treatment in the remaining 5 cases. All patients with conservative treatment were recorded at the beginning of the experience.
Conclusions
Slippage is a possible complication after LBCG. This classification of the different types of slippage can benefit the surgeon in the management and treatment of this complication of LBCG.
Graphical Abstract
... To overcome LSG's limitations, a promising bariatric procedure has been proposed: laparoscopic vertical clip gastroplasty (LVCG) using the BariClip device, which follows principles of LSG, but may have fewer associated risks and improved long-term results. The procedure, characterised by a completely reversible mechanism, consists of a nonadjustable clip that is vertically placed parallel to the lesser curvature of the stomach, separating the stomach in a medial restricted alimentary segment and a lateral excluded segment, effectively mimicking LSG, without requiring stapling, resection, or change in anatomy [3][4][5]. ...
... Placed as described, the laparoscopic BariClip gastroplasty (LBCG) will address a similar restriction with the LSG at the level of the gastric fundus, while remaining the advantage of simplicity and anatomic preservation. In addition, early data shows comparable early results to the gastric sleeve with less complications [6][7][8]. ...
... Our initial technique [6,8] involved simple placement of the clip with suture fixation of the BariClip silicone outer layer to the anterior and posterior gastric wall. It was then decided to add a gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" through between the limbs of the clip. ...
... To overcome these limitations, Jacobs et al. [6] have proposed the laparoscopic BariClip gastroplasty (LBCG) as the alternative. In previous study [8], we reported that LBCG offers acceptable weight loss and improvement in the quality of life with the same principles as LSG while offering several distinct advantages. There is no risk of leakage. ...
Introduction:
Laparoscopic BariClip gastroplasty (LBCG) will address a similar tubular restriction than the one achieved with the laparoscopic sleeve gastrectomy (LSG) at the level of the gastric fundus, while maintaining the advantage of simplicity and anatomic preservation. The purpose of the current study was to analyze the risk of slippage and to present the evolving technique by adding gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" between the limbs of the clip.
Methods:
All patients undergoing LBCG with the evolving technique of gastric plication around the device associated with antral gastroplasty from January 2021 to May 2022 were included in the study group (group A). A control group (group B) was designed with patients who underwent previous LBCG technique between May 2017 and June 2019. This is a case-controlled group with patients matched by gender and BMI. We have analyzed the postoperative complications and more notably the slippage.
Results:
One hundred seventy-six patients (44 male and 132 female) with a mean age of 33 years (± 11) underwent evolving technique of LBCG. A control group of 67 patients who underwent previous technique of LBCG was included. All procedures were completed by laparoscopy with no intraoperative complication. For the study group, we have recorded a number of 5 slippages (2.8%). The diagnosis occurred during the first 6 months after the operation. The management consisted of repositioning-3 cases-and BariClip removal-2 cases. For the control group, we have recorded a number of 3 slippages (4.3%). All three patients underwent BariClip removal, with no repositioning.
Conclusions:
We reported a new technique of placement of the BariClip with additional gastric plication anterior, posterior, and volume reduction in the antrum to potentially reduce the rate of slippage and improve weight loss outcomes.
... All procedures were performed according to Jacobs et al. [9] and the further technical modifications by Noel et al. [14,15]. Patients were placed in a lithotomy position, using four or five laparoscopic ports. ...
... For this same reason, although other sources of hemorrhage certainly exist in LVCG, the hemorrhage rate is expected to be reduced significantly. In fact, there was no such instances in our series, nor was it reported previously [9,14]. Weight regain after SG is most often related to dilatation of the stomach with time. ...
... In other words, it seems that a device-related narrowing of the gastric lumen should allow for a longer-lasting restriction with potentially improved weight loss outcomes. Lateral slippage of the clip may increase the gastric lumen and impair results in terms of weight loss, but this complication appears relatively rare (3-7.7% slippage rate) [9,14]. GERD and Barrett's esophagus may be considered SG's real Achilles' heel, occurring in up to 59% and 16% of SG patients, respectively, needing conversion to RYGB in 4% and representing the indication for 30% of re-do BS after SG [30][31][32][33][34]. ...
PurposeSleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip.Materials and Methods
Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution.ResultsPatients had a mean age of 44 years and mean BMI of 37 kg/m2 ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases.Conclusion
The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG.Graphical Abstract
... Laparoscopic BariClip gastroplasty (LBCG) could answer the need for a no-resection procedure. LBCG offers a higher restriction than the endoscopic procedures with the advantage of the reversibility by clipping without cutting the stomach; the LBCG procedure almost replicates the effectiveness of the LSG with minimal complications [12,13]. The procedure is performed using a nonadjustable clip that is vertically placed parallel to the lesser curvature. ...
... To overcome these limitations, Jacobs et al. [10] endorsed the Laparoscopic BariClip Gastroplasty as the alternative. In the previous study [13], we reported that LBCG offers an acceptable quality of life with the same principles as LSG and presents several advantages. There is no risk of leak or bleeding, and the LBCG remains a reversible bariatric procedure, and in the case of invalidating GERD, the BariClip can be removed with no complications-allowing, as needed, an antireflux procedure to be performed on a normal stomach. ...
Introduction:
Laparoscopic BariClip Gastroplasty (LBCG) represents a new bariatric procedure that mimics the principle of the Laparoscopic Sleeve Gastrectomy (LSG), but using a completely reversible mechanism, which is essential for gastroesophageal reflux disease (GERD). The purpose of our study was to evaluate the evolution of GERD following the initial experience with LBCG.
Methods:
The first 43 obese patients who underwent LBCG performed by the same surgeon in two different medical centers in May 2018-December 2019 were included in the current study. Twelve patients had issues of reflux, regularly receiving PPIs (proton pump inhibitors) treatment in eight cases, and occasionally in four cases. Thirty-two patients completed the follow-up at one year and the GERD was evaluated using the PPI medications and the GerdQ.
Results:
The median preoperative GerdQ score was (14.58 ± 1.9). Three patients out of the twelve who had complained about preoperative GERD did not consent to the one year follow-up form. For the rest of nine patients, the median post-operative GerdQ score was (10.11 ± 3.2). The PPIs were used at one year follow-up in six patients: four with occasional use, one patient with regular use showing no improvement, and one who experienced de novo GERD symptomatology (3.1%). No statistically significant difference between the groups was recorded in terms of GERD. We recorded no intraoperative complications. No case of erosion occurred in the post-operative period, but we encountered two cases of slippage. One additional BariClip was removed at 14 months.
Conclusion:
LBCG represents a new bariatric procedure that mimics the principle of the laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. Even with limited cases, our experience reports several mechanisms of action that will be evaluated and discussed in further prospective clinical trials. After this preliminary clinical study, LBCG's effects on GERD and its safety are highly encouraging.
... Subsequently, a device with similar principle, the vertical gastric clip (Jacobs et al., 2017;Noel et al., 2018) or BariClip (Noel et al., 2020), was used in patients. Parallel to the lesser curvature, the device separates a medial lumen from an excluded lateral gastric pouch (Jacobs et al., 2017). ...
... The reduction of BMI and % excess weight loss were 12.7 and 66.7, respectively, at 2 years after the operation (Jacobs et al., 2017). In addition, the quality of life was improved in more than 90% of patients (Noel et al., 2018). A simpler device named Gastric Clip (Chao et al., 2019) was also used in clinics. ...
Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.
... This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. The nonadjustable clip is placed vertically parallel to the lesser curvature [1,2]. Its proponents claim that the clip restricts oral intake without changing small bowel anatomy, requires no stapling, causes no malabsorption, does not require any maintenance or surveillance, and is reversible. ...
Introduction:
Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date.
Methods:
A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m2 underwent a laparoscopic calibrated tubular gastroplasty at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination: BMI 28.9 kg/m2, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located medially to the esophagogastric junction, the lesser curvature, and the antropyloric region.
Results:
A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no postoperative complications.
Conclusion:
This video demonstrates a form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using a laparoscopic approach.
