Endoscopic band ligation for weight regain and severe reflux after sleeve gastrectomy. Weight regain and severe reflux are common challenges after sleeve gastrectomy. Revisional surgeries are effective but associated with higher risks and patient reluctance. Endoscopic band ligation has shown promising results in primary cases for weight loss, inducing restriction and early satiety. This study explores band ligation as a novel minimally invasive solution for weight regain and refractory reflux in post-sleeve gastrectomy patients. Our case is a 35-year-old female, 10 years post-sleeve gastrectomy, presented with weight regain, her BMI is 40, and she is complaining of severe reflux, refractory to double dose of PPIs. She is unwilling to undergo revisional surgery and she opted for endoscopic band ligation. 16 bands were placed at 3 regions, 4 in the distal esophagus below Z-line, 8 in the gastric body and 4 in the antrum as seen in the picture. The procedure took 25 minutes with no immediate complications. The patient was discharged in 2 hours and she is complaining of mild nausea and pain managed pharmacologically in the first 2 days only. Endoscopic examination was done in the endoscopy unit, and we used Propofol for deep sedation and we used oxygen for air insufflation. We inspect the esophagus, then the stomach body, and then the antrum. And we decided to place multiple bands at 3 regions, starting in the antrum, then the body of the stomach, then the distal esophagus. The procedure is very easy and required minimal training. The most common complaint after band ligation is pain and nausea for 1-2 days, and it is relieved by medication. After the procedure, the patient was prescribed pureed diet for 2 weeks, then soft diet for another 2 weeks. We placed 4 bands in the gastric antrum, then we moved to the body and placed 8 bands in the gastric body. Now we are doing band ligation in the gastric body. We removed the esophagus, and we placed four bands in the distal esophagus, just below the deadline, trying to do a pseudocardia to decrease the reflux, as the patient is complaining of severe reflux symptoms, she cannot sleep for a couple of years, and not responding to double daily dose of PPIs. The whole procedure took about 25 minutes, and the patient did very well, and was discharged from the hospital after two hours. This is the final band ligation in the esophagus, we placed four bands below the Z-line. And now you will see the end results here the four bands in the antrum The eight bands in the gastric body And finally The four bands in the autophagus Our case lost 15 kilograms presenting 13% total weight loss at one month Her BMI dropped to 34. She had complete resolution of reflux symptoms from day one She experienced early satiety and prolonged satiation Her GCSI score increased 1.33 In the scopic band, ligation offers a novel, effective and safe approach for managing weight regain and severe reflux post-sleep gastrectomy Encourages further research to validate findings and expand clinical use

endoscopic band ligation

weight regain

sleeve gastrectomy

reflux resolution

minimally invasive