Current applications of endoscopic suturing

Figure 8 Suture placement needed to achieve endoscopic sleeve gastroplasty. A: Schematic of the configuration of sutures used to achieve endoscopic sleeve gastroplasty. Initially 5 to 8 plication sutures are placed along the greater curvature in a distal to proximal direction, followed by placement of an inner row of 2 to 3 short anterior/posterior “retention sutures” that take some of the tension off the plication sutures; B: Using APC ablation two lines are made along the anterior and posterior wall that mark the outer borders of the plication sutures; C: The first plication suture is placed within 3 cm of the pylorus where due to the narrowing of the lumen results in a modified 5-point suture with the first bites placed on the anterior and posterior wall of the antrum while the 3^rd, 4^th and 5^th bites are placed on the anterior wall, greater curvature and posterior wall; D, E: Subsequent plication sutures all have the same 6 point configuration (anterior wall, greater curvature, posterior wall, anterior wall, greater curvature, posterior wall); F: The inner row of retention sutures consists of sutures of sutures between the anterior and posterior wall a shown (Courtesy Apollo Endosurgery Austin Texas).