We currently offer an endoscopic revision procedure to treat weight regain after sleeve gastrectomy, called sleeve-in-sleeve (SIS).
This is a newer procedure that was developed at Brigham and Women’s Hospital in 2018. We currently are the only site on the East Coast that is approved to perform this procedure.
SIS is a revision procedure, meaning it's only appropriate for certain patients who’ve already had a sleeve gastrectomy.
SIS is an endoscopic plication treatment for sleeve gastrectomy patients who are struggling with weight regain. When weight regain happens, it can be due to some stretching of the sleeve. SIS is an endoscopic procedure that helps restore the tightness of the sleeve to the size it originally was following the surgery. SIS works by using sutures to create plications (folds) to decrease the volume of the sleeve.
While under anesthesia, your doctor inserts the endoscopic system into your mouth and passes it into your gastric sleeve. The system has several components that are used together to fold and fuse the stomach. Several plications are placed to make the sleeve smaller.
SIS typically takes less than an hour to complete. SIS is a minimally invasive endoscopic procedure, so it doesn’t require any incisions on the outside of your body and you won’t have any external scars. The recovery time is also much faster than traditional surgery.
Your expected weight loss can vary with SIS and it likely depends on how much weight was regained after sleeve gastrectomy. SIS is very effective at restoring the structure of the sleeve, which can help reinitiate weight loss.
After SIS, you will need to stay overnight at the hospital and take a few days off from work to recover. During recovery, you are first prescribed a special liquid meal plan. Over time, you transition to a soft food plan (including easy-to-eat foods, like oatmeal, bananas, and soft-cooked rice) and then return to normal eating. For an SIS procedure, there is no lifting restriction.
You might experience better health, like improvements in weight-related health conditions. These can include sleep apnea, high blood pressure, type 2 diabetes, fatty liver and dyslipidemia. Dyslipidemia is when you have abnormal amounts of lipids (fats) in your blood. In some cases, these conditions may even resolve completely.
You must have had a previous sleeve gastrectomy with an enlarged sleeve to qualify for this procedure. There are no strict body mass index (BMI) criteria for this procedure.
You can meet with your doctor to ask any questions you may have about SIS. We know it can be depressing or discouraging for some patients to regain weight after a sleeve gastrectomy procedure. We offer psychological support to patients who are undergoing revision treatments by collaborating with mental health specialists. We also have dieticians who can work with you before and after the procedure to adopt and maintain a healthy lifestyle.
Yes. We take a collaborative approach to treatment that combines the expertise of many different specialists, including dietitians and, mental health professionals. Our team-based approach helps us offer a very high quality of care.
Christopher Thompson, MD, MSc, AGAF, FASGE, FACG
Co-director of Center for Weight Management and Wellness
Director of Endoscopy
Director of Bariatric Endoscopy
Pichamol Jirapinyo, MD, MPH, ABOM
Associate Director of Bariatric Endoscopy
Director of Bariatric Endoscopy Fellowship
If you would like more information or would like to schedule an appointment with a Brigham doctor, you can call us at 617-525-3597 or fill out our appointment request form.
Physicians who are looking to refer a patient can call 617-525-3597 or email us at firstname.lastname@example.org.
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