Bariatric reduction system – BARS: device, technique and first clinical experience

Abstract

Background

Roux-en-Y gastric by-pass (RYGB) is one of the most effective bariatric procedures, but the rate of weight regain (WR) can reach 63% after the second year. Enlargement of the gastrojejunal anastomosis is one of the reported causes. A newly CE-marked flexible endoscopic system, Bariatric Anastomotic Reduction System (BARS) (Ovesco Endoscopy, Tuebingen, Germany), derivative of the well-established endoscopic over-the-scope-clip (OTSC) clipping system, has been recently developed. It was tested in pre-clinical and preliminary clinical use for feasibility and effectiveness in bariatric anastomotic reduction.

Material and methods

Using a single-channel endoscope with external supplemental working channel, the BARS device captures the two limbs of the anastomosis, reducing its size, thus slowing food passage. After preclinical assessment, six patients with at least a 15% WR and the presence of an enlarged gastrojejunostomy > 20 mm were enrolled. The mean patient age was 49 years (range 24–67). Average interval between gastric bypass and BARS procedure: 8 years (4–13).

Results

All procedures were safely performed without complications. Mean procedure time: 52 min (37 − 75). Preliminary results: mean weight loss 6 kg (4–9) at a 3-month FU.

Conclusions

BARS could be a promising endoscopic system in case of WR after gastric bypass due to enlargement of the anastomosis.

Keywords:

• Bariatric reduction system
• anastomotic dilation

Acknowledgements

The authors thank Raphael Pilz, Tuebingen for his support during ex vivo experiments and their documentation.

Declaration of interest

Marc Schurr and Thomas Gottwald are members of the executive board of Ovesco Endoscopy, Antonio Caputo is employee of Ovesco Endoscopy, Tuebingen. The other authors declare no conflict of interest.