Here we present a dual-mechanism dynamic anchoring bypass system for obesity and metabolic diseases. There is currently an unmet need for minimally invasive endoscopic devices to fill the gap between medical and surgical management of obesity. There's a need for organ-sparing, safe and effective intervention that have no long-term consequences to health and minimally disruptive to the patient's lifestyle. Here we present a novel endoscopic bariatric and metabolic device with dual mechanism of action. It has a gastric component that bypasses the antrum and delays the emptying of the stomach and a small intestinal component that bypasses the proximal small intestines for metabolic benefit. The device utilizes a novel anti-migration system that suspends the device between two points and the forces of the motility of the GI tract are being canceled by a dynamic coil and suspension system that keeps the device in equilibrium and minimize migration and damage to the organ it is anchored at. Thus, just like an accordion, the device is moving with the motility of the gastrointestinal tract. It's compatible with both a laparoscopic or an endoscopic EUS-guided gastrointestinal system. After securing the wire, the device is pulled in place using standard peg-like pull technique and is anchored across the gastrointestinal anastomosis as shown in this figure. The dynamic anti-migration features of this device are well demonstrated in this video. We attempt displacement of the device and as you could see, the device returned to its original configuration both by pulling on the antrum occluder and on the gastrointestinal anchoring system demonstrated in this video. The device is capable of completely occluding the antrum and diverting food to the distal small intestines as demonstrated in this radiogram. In two survival porcine experiments, the device was very effective in halting weight regain compared to controlled pegs as demonstrated in the yellow and orange graphs compared to the blue and gray graphs of the growing pegs. No device migration was observed on weekly radiographs and no trauma was observed in the GI tract at necropsy. In addition, we demonstrated that we could reduce the gastric volume further using an endoscopic sleeve gastroplasty approach on top of the implanted device as an enhanced mechanism for additional weight loss. After deployment of the gastrointestinal bypass device, we intubated an endoscopic suturing device to the stomach. In the mid-body portion, we started the endoscopic suturing using an endoscopic sleeve gastroplasty technique. We started the suturing line on the anterior gastric wall and we use a continuous suturing method utilizing U-shaped 2-O-proline sutures. We utilize a helical retractor to obtain full thickness acquisition of the gastric wall. Here we're demonstrating suturing along the greater curvature and back to the anterior gastric wall to complete the U-shaped suture. Here we cinch the suturing sequence as demonstrated. Two additional sutures were placed proximally in a U-shaped pattern to complete the endoscopic sleeve gastroplasty. The last suture is being cinched as shown here. On completion endoscopy, we could demonstrate excellent volume restriction of the stomach from the endoscopic sleeve gastroplasty. Here we enter the gastrointestinal anastomosis to the efferent jejunal limb because the proximal efferent limb is being bypassed by the antero-occluded portion of the device. Again here we're demonstrating the anchoring at the level of the gastro-jejunostomy with demonstration of the efferent limb and here we also demonstrate the antero-occluder device occluding and bypassing the antero of the stomach with proximal endoscopic sleeve gastroplasty as demonstrated. In conclusion, we demonstrate an anatomy-preserving endoscopic or modular gastrointestinal bypass system showing its feasibility and its ability to mimic the efficacy of bariatric and metabolic surgery. The dynamic dual anchoring bypass system demonstrated in this video is novel, can prevent device migration, and is scalable to the average endoscopist.

endoscopic bariatric device

metabolic diseases

minimally invasive interventions

gastric component

small intestinal component