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Laparoscopic Clip Gastroplasty with the BariClip

Authors:
Patrick Noel at Phi Medcare
Patrick Noel
  • Phi Medcare
Imane Eddbali at Independent Researcher
Imane Eddbali
  • Independent Researcher
Marius Nedelcu at Clinique Saint Michel, Toulon, France
Marius Nedelcu
  • Clinique Saint Michel, Toulon, France
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Abstract

Having the advantages of the reversibility by clipping and not cutting the stomach, the BariClip procedure reproduces the effect of the SG [1, 2] without adding the risk of leaks, and minimizes the occurrence of postoperative GERD by decreasing the intragastric pressure [3]. We present an edited video on the placement of a BariClip with the main steps of the procedure for a female patient with a BMI 41 kg/sqm. A 36 F bougie is placed to calibrate the size of the pouch. Using a laparoscopic approach, the BariClip is placed into the peritoneal cavity through a 12 mm trocar. The BariClip is then closed around the stomach parallel to the lesser curvature, creating a small medial pouch and an excluded large lateral segment. To prevent slippage (rate is approximately 3%), the BariClip is sutured to the gastric wall both anteriorly and posteriorly at various levels of the stomach, as shown in the video. Despite the possibility to suture on either side of the BariClip, the left indentations are preferred in order to avoid vessels of the lesser curvature which are closer to the right indentations. The recovery was uneventful, and 4 h after the surgery, the patient was tolerating liquids. She was discharged the following day with a prescription of PPI (pantoprazole 40 mg) for 30 days and of clexane 0.4 IM for 5 days. As with most bariatric procedures, she was started on 2 weeks of liquids, followed by 2 weeks of soft diet, before experiencing solid food. At 1 month after surgery, the patient had lost 10% of her TBW, and at 1-year follow-up, she had lost 31% of her TBW. She had no reflux, pain, or any other complaints and was very happy. The closing of the BariClip has been designed to be a low-pressure system, and in addition, it has a wide inferior outlet (2.5 cm), which does not create high intraluminal pressure. Both of these factors result in a low risk of erosion and of GERD. The rate of erosion in the original series was 1.3% with up to a 7-year history of implantation. The most common complication encountered at the beginning of our experience has been a slippage of the BariClip, and with the learning curve, this rate dropped to 3%. The QOL has been studied on a first series of patients and showed good results comparable with those given with the LSG and the RYGB [4]. In conclusion, the BariClip accomplishes almost similar weight loss as a SG, without a gastrectomy, without risks of leaks, and without causing reflux, and at the same ,time the BariClip is reversible [5].
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MULTIMEDIA ARTICLE
Laparoscopic Clip Gastroplasty with the BariClip
Patrick Noel
1,2,3
&Imane Eddbali
3
&Marius Nedelcu
4
#Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Having the advantages of the reversibility by clipping and not cutting the stomach, the BariClip procedure reproduces the effect
of the SG [1,2] without adding the risk of leaks, and minimizes the occurrence of postoperative GERD by decreasing the
intragastric pressure [3]. We present an edited video on the placement of a BariClip with the main steps of the procedure for a
female patient with a BMI 41 kg/sqm. A 36 F bougie is placed to calibrate the size of the pouch. Using a laparoscopic approach,
the BariClip is placed into the peritoneal cavity through a 12 mm trocar. The BariClip is then closed around the stomach parallel
to the lesser curvature, creating a small medial pouch and an excluded large lateral segment. To prevent slippage (rate is
approximately 3%), the BariClip is sutured to the gastric wall both anteriorly and posteriorly at various levels of the stomach,
as shown in the video. Despite the possibility to suture on either side of the BariClip, the left indentations are preferred in order to
avoidvesselsofthelessercurvaturewhichareclosertotherightindentations.Therecoverywasuneventful,and4hafterthe
surgery, the patient was tolerating liquids. She was discharged the following day with a prescription of PPI (pantoprazole 40 mg)
for 30 days and of clexane 0.4 IM for 5 days. As with most bariatric procedures, she was started on 2 weeks of liquids, followed
by 2 weeks of soft diet, before experiencing solid food. At 1 month after surgery, the patient had lost 10% of her TBW, and at 1-
year follow-up, she had lost 31% of her TBW. She had no reflux, pain, or any other complaints and was very happy. The closing
of the BariClip has been designed to be a low-pressure system, and in addition, it has a wide inferior outlet (2.5 cm), which does
not create high intraluminal pressure. Both of these factors result in a low risk of erosion and of GERD. The rate of erosion in the
original series was 1.3% with up to a 7-year history of implantation. The most common complication encountered at the
beginning of our experience has been a slippage of the BariClip, and with the learning curve, this rate dropped to 3%. The
QOL has been studied on a first series of patients and showed good results comparable with those given with the LSG and the
RYGB [4]. In conclusion, the BariClip accomplishes almost similar weight loss as a SG, without a gastrectomy, without risks of
leaks, and without causing reflux, and at the same ,time the BariClip is reversible [5].
Keywords BariClip .Laparoscopic clip gastroplasty .Laparoscopic BarriSleeve .Video .Laparoscopic sleeve gastrectomy
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Human Animal Rights and Informed Consent All procedures performed
in studies involving human participants were in accordance with the
ethical standards of the institutional and/or national research committee
and with the 1964 Helsinki declaration and its later amendments or com-
parable ethical standards.
Informed consent Informed consent was obtained from all individual
participants included in the study.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11695-020-04803-x) contains supplementary
material, which is available to authorized users.
*Patrick Noel
casanoel@gmail.com
1
Mediclinic Parkview Hospital, Dubai, United Arab Emirates
2
ELSAN, Clinique Bouchard, Marseille, France
3
Emirates Specialty Hospital, Dubai, United Arab Emirates
4
ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité,
Toulon, France
https://doi.org/10.1007/s11695-020-04803-x
Published online: 29 September 2020
Obesity Surgery (2020) 30:5182–5183
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The BariClip is then closed 102 around the stomach parallel to the lesser curvature, creating a small medial pouch and an 103 excluding large lateral segment (Figure 4). To prevent slippage, the BariClip ® is sutured 104 to the gastric wall both anteriorly and posteriorly at various levels of the stomach [15]. CP procedure reproduces the effect of the sleeve gastrectomy with the advantage of the reversibility by clipping and not cutting the stomach. ...
... The BariClip is then closed around the stomach parallel to the lesser curvature, creating a small medial pouch and an excluding large lateral segment ( Figure 4). To prevent slippage, the BariClip ® is sutured to the gastric wall both anteriorly and posteriorly at various levels of the stomach [15]. CP procedure reproduces the effect of the sleeve gastrectomy with the advantage of the reversibility by clipping and not cutting the stomach. ...
... The BariClip is then closed around the stomach parallel to the lesser curvature, creating a small medial pouch and an excluding large lateral segment ( Figure 4). To prevent slippage, the BariClip ® is sutured to the gastric wall both anteriorly and posteriorly at various levels of the stomach [15]. ...
Common, Less Common, and Unexpected Complications after Bariatric Surgery: A Pictorial Essay
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  • Oct 2022
Bariatric surgery has demonstrated a higher rate of success than other nonsurgical treatments in selected patients with obesity; however, like all medical procedures, postoperative complications may occur, ranging between 2 and 10% and, although rare, they can be life threatening. Complications may be unspecific (any surgery-related complications) or specific (linked to the specific surgical procedure) and can be distinguished as common, less common, and unexpected. According to the onset, they may be acute, when occurring in the first 30 days after surgery, or chronic, with a presentation after 30 days from the procedure. The aim of this pictorial essay is to review the radiological aspects of surgical techniques usually performed and the possible complications, in order to make radiologists more confident with the postsurgical anatomy and with the normal and abnormal imaging findings.
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... LSG is irreversible, and if GERD does not respond to antireflux medications, conversion to other bariatric procedure like Roux-en-Y gastric bypass surgery (RYGB) may be required. To overcome these limitations and standardize a reversible restrictive technique with comparable results, a new bariatric procedure [8], laparoscopic BariClip gastroplasty (LBCG), has been developed. ...
... As is known, one of the most frequent complications after sleeve gastrectomy is the onset of symptoms and signs of reflux, with an incidence of 2.6-35% [14]. Noel et al. in two studies [8,15] reported an improvement of GERD symptoms after positioning of BariClip. This has been explained by several mechanisms: minimal dissection of the His angle, no damage of the phreno-esophageal membrane, and the presence of a distal opening at the bottom of the BariClip make the procedure a low-pressure system [16]. ...
BariClip: Outcomes and Complications from a Single-Center Experience
Article
Full-text available
  • Oct 2024
  • OBES SURG
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.
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... The BariClip consists of a silicone covering around a titanium body. The product specifics and placement technique were previously described [7]. ...
... 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]. ...
Evolving Technique of Laparoscopic Vertical Gastric Clip Placement
Article
Full-text available
  • Feb 2023
  • OBES SURG
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.
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... 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]. ...
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... 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. ...
Safety and Efficacy of Laparoscopic Vertical Clip Gastroplasty: Early Results of an Italian Multicenter Study
Article
Full-text available
  • Dec 2022
  • OBES SURG
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
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... 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). ...
Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices
Article
Full-text available
  • Oct 2021
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.
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Laparoscopic Vertical Clip Gastroplasty – Quality of life
Article
Full-text available
  • Jul 2018
  • SURG OBES RELAT DIS
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 the bariatric armamentarium necessitated a period of preclinical and clinical studies and a validation of the procedure concerning the quality of life. Setting Private hospital, Dominican Republic. Objectives The purpose of this manuscript was to evaluate patient satisfaction, measured by various questionnaires after LVCG. Methods From November 2012 to February 2017, 138 patients underwent LVCG and demographic data were collected prospectively. A total of 82 were evaluated for quality of life with a minimum follow-up of 6 months after the procedure. The quality of life was also analyzed regarding the complications and resolution of different medical conditions included in the Bariatric Analysis and Reporting Outcome System score. Results Eighty-five patients (73.9%) agreed to participate in the study and a total of 82 patients completed the questionnaires at all points in time. Seventy-one patients were female, with an average age of 34 (19–38). Mean body mass index before operation was 42.4 kg/m² and declined significantly in both the first and second year postoperatively to 33.7 kg/m² (1-year follow-up) in 65 patients and 34.3 kg/m² (2-year follow-up) in 37 patients. The results showed failure for 1.2% of patients and were fair for 6.1% of cases. Quality of life was assessed as good for 26 patients (31.8%), as very good for 39 patients (47.5%), and as excellent for 11 patients (13.4%). Conclusions LVCG represents a new bariatric procedure that mimics the principle of laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. The procedure consists of a nonadjustable clip that is vertically placed parallel to the lesser curvature. After >3 years of clinical use, the weight loss results seem to be encouraging and up to 92.7% of patients have an improved quality of life.
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Long term results (8 years) after sleeve gastrectomy?
Article
Full-text available
  • Mar 2017
  • SURG OBES RELAT DIS
Background Laparoscopic sleeve gastrectomy (LSG) became the most frequent bariatric procedure performed in France (2011) and in the United States (2013), but studies reporting long-term results are still rare. Setting Private hospital, France. Methods This is a retrospective analysis of a prospective cohort of 168 patients who underwent LSG between 2005 and 2008. The objective of this study was to present the 8-year outcome concerning weight loss, modification of co-morbidities, and to report the revisional surgery after sleeve. Results The preoperative mean body mass index was 42.8 kg/m2 (31.1–77.9), 35 patients were super obese, and 64 patients had a previous gastric band. For LSG as a definitive bariatric procedure, 8 years of follow-up data were available for 116 patients (follow-up: 69%). Of the remainder, 23 patients underwent revisional surgery and 29 were lost to follow-up. For the entire cohort, the mean excess weight loss (EWL) was 76% (0–149) at 5 years and 67% (4–135) at 8 years, respectively. Of the 116 patients with 8 years of follow-up, 82 patients had>50% EWL at 8 years (70.7%). Percentages of co-morbidities resolved were hypertension, 59.4%; type 2 diabetes, 43.4%; and obstructive sleep apnea, 72.4%. Twenty-three patients had revisional surgery for weight regain (n = 14) or for severe reflux (n = 9) at a mean period of 50 months (9–96). Twelve patients underwent resleeve gastrectomy, 6 patients underwent conversion to a bypass, and 5 patients to duodenal switch (1 single anastomosis duodeno-ileostomy). A total of 31% of patients reported gastroesophageal reflux symptoms at 8 years. Conclusions At 8 years postoperatively, the LSG as a definitive bariatric procedure remained effective for 59% of cases. The results appear to be more favorable especially for the non-super-obese patients and primary procedures. LSG is a well-tolerated bariatric procedure with low long-term complication rates.
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A Vertically Placed Clip for Weight Loss: a 39-Month Pilot Study
Article
Full-text available
  • May 2017
  • OBES SURG
Background: Morbid obesity remains one of society's significant medical dilemmas. It is rapidly worsening and expected to affect 35% of the US population by the year 2020. Common current bariatric procedures exist and include, but not limited to, the adjustable gastric band, gastric bypass, and the sleeve gastrectomy. Although beneficial to morbidly obese patients, they also alter the patient's anatomy and involve resections, or require maintenance. The goal of the trial is to show a new minimally invasive vertical gastric clip technique that produces significant weight loss but requires no resection, no change in anatomy, and is reversible. Methods: From November 2012 to February 2016, prospective collected data from 117 patients was included in the gastric clip trial. The 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. Results: Weight loss and comorbidities were evaluated among 117 patients over a 39-month period. 66.7% excess weight loss was seen with minimal adverse events. Average length of surgery was 69 min. Average length of stay was 1.3 days. Fifteen of the originally implanted clips were electively removed based on the original protocol, and the other two were removed for displacement of the device. Conclusion: The vertical, gastric clip trial has shown that excellent weight loss can be achieved without some of the complications seen with historical bariatric procedures. This clip is placed without requiring stapling, resection, malabsorption, change in anatomy, or maintenance. It is also easily reversible.
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Fifth International Consensus Conference: Current Status of Sleeve Gastrectomy
Article
  • Jan 2016
Background: For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience. Objectives: To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices. Setting: International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada. Methods: In August 2014, expert surgeons (based on having performed>1000 cases) completed an online anonymous survey. Identical survey questions were then administered to general surgeon attendees. Results: One hundred twenty bariatric surgeons completed the expert survey, along with 103 bariatric surgeons from IFSO 2014 general surgeon audience. The following indications were endorsed: as a stand-alone procedure (97.5%); in high-risk patients (92.4%); in kidney and liver transplant candidates (91.6%); in patients with metabolic syndrome (83.8%); body mass index 30-35 with associated co-morbidities (79.8%); in patients with inflammatory bowel disease (87.4%); and in the elderly (89.1%). Significant differences existed between the expert and general surgeons groups in endorsing several contraindications: Barrett's esophagus (80.0% versus 31.3% [P<.001]), gastroesophageal reflux disease (23.3% versus 52.5% [P<.001]), hiatal hernias (11.7% versus 54.0% [P<.001]), and body mass index>60 kg/m(2) (5.0% versus 28.0% [P<.001]). Average reported weight loss outcomes 5 years postoperative were significantly higher for the expert surgeons group (P = .005), as were reported stricture (P = .001) and leakage (P = .005) rates. The following significant differences exist between 2014 and 2011 expert surgeons: Patients with gastroesophageal reflux disease should have pH and manometry study pre-laparoscopic sleeve gastrectomy (32.8% versus 50.0%; P = .033); it is important to take down the vessels before resection (88.1% versus 81.8%; P = .025); it is acceptable to buttress (81.4% versus 77.3%; P<.001); the smaller the bougie size and tighter the sleeve, the higher the incidence of leaks (78.8% versus 65.2%; P = .006). Conclusion: This study highlights areas of new and improved best practices on various aspects of laparoscopic sleeve gastrectomy performance among experts from 2011 and 2014 and among the current general surgeon population.
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Laparoscopic sleeve gastrectomy and gastroesophageal reflux
Article
  • Sep 2015
  • WORLD J GASTROENTERO
Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery.
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