ASGE DDW Videos from Around the World | 2026-ENDOSCOPIC CLOSURE OF SASI ANASTOMOSIS WITH SLEEVE POUCH RESIZING FOR REFRACTORY BILIARY ESOPHAGITIS- A MINIMALLY INVASIVE ALTERNATIVE TO SURGICAL REVISION

ENDOSCOPIC CLOSURE OF SASI ANASTOMOSIS WITH SLEEVE POUCH RESIZING FOR REFRACTORY BILIARY ESOPHAGITIS- A MINIMALLY INVASIVE ALTERNATIVE TO SURGICAL REVISION

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Video Transcription

Video Summary

A 35-year-old woman developed refractory biliary esophagitis after single-anastomosis sleeve–ileal bypass (SUSI) with a dilated sleeve pouch. Instead of major revisional surgery, she underwent an entirely endoscopic treatment: argon plasma coagulation, full-thickness purse-string closure of the gastroileal anastomosis, and endoscopic sleeve resizing with U-pattern sutures. The procedure successfully eliminated bile reflux while preserving restrictive anatomy. At 2 months, she had complete symptom resolution, no nocturnal GERD, stable weight, and normal nutrition. This case suggests endoscopic anastomotic closure with sleeve resizing may be a minimally invasive alternative for refractory bile reflux after bariatric bypass.

Asset Subtitle

Submitted by Maryam AlKhatry

Keywords

biliary esophagitis

single-anastomosis sleeve-ileal bypass

endoscopic treatment

bile reflux

sleeve resizing