fig4

Figure 4. Endoscopic sleeve gastroplasty using the Overstitch NXT. (A) The device under endoscopic view; (B) Endoscopic suturing starts from the level of the gastric incisura. Tissue helix is used to draw the gastric wall into the suturing device to perform a full-thickness bite; (C-E) Needle drive through the gastric wall to achieve full-thickness suturing; (F) A neo-pylorus is created after the first row of plication; (G) Further plications made at greater curvature in a U suturing pattern; (H) Final endoscopic appearance after completion of ESG showing the sleeve-like stomach; (I) The barium meal study conducted one year after ESG shows a narrow, sleeve-like gastric body with delayed emptying and retained contrast in the fundal pouch. ESG: Endoscopic sleeve gastroplasty.