This article is more than 5 years old. Information may no longer be current.
Endoscopic sleeve gastroplasty possible alternative to bariatric surgery in certain obese patients
Endoscopic sleeve gastroplasty led to weight loss in a prospective study of patients with obesity. It was also shown to delay gastric emptying and induce early satiation, making it a possible minimally invasive alternative to bariatric surgery in a select group of patients with obesity.
In the study, Barham K. Abu Dayyeh, MD, MPH, of the developmental endoscopy unit, and clinical enteric neuroscience translational and epidemiological research, division of gastroenterology and hepatology, department of medicine, Mayo Clinic, evaluated the durability and effects of endoscopic sleeve gastroplasty (ESG) on 25 patients. Most of the patients were women (n = 21), and the mean age was 47.6 years (± 10 years). All patients had ESG with endoluminal creation of a sleeve along the gastric lesser curve. The procedures were performed at Mayo Clinic between September 2012 and March 2015. Follow-up evaluations were performed for a median of 9 months.
Barham K. Abu Dayyeh
The researchers conducted analyses on four of the patients before and after the ESG procedure to measure solid and liquid gastric emptying. The analysis also measured satiation, and fasting and post-prandial levels of insulin, glucose and gut hormones.
At the 6, 9, 12 and 20 month follow-up periods, patients lost an average of 53%, 56%, 54%, and 45% of their excess body weight, respectively (P < .01). Moreover, at 3 months follow-up, endoscopy showed intact gastroplasty in all of the patients.
In the four patients that underwent further pre- and post-ESG evaluation, all four showed a decrease in caloric consumption to reach maximum fullness by 59% (P = .003). All four patients also showed increased insulin sensitivity (P = .06), along with a slowing of gastric emptying (P = .03), according to the study.
The adverse events of perigastric inflammatory collection, pulmonary embolism, and a small pneumothorax occurred in three patients. While all three patients fully recovered, the researchers wrote: “We did observe three serious adverse events in the study, and in response we have changed our clinical protocols.”
“In this study, we demonstrate the efficacy of ESG as a minimally invasive endoscopic intervention for obesity. ESG produced similar [percent excess weight loss] at 1 year to laparoscopic adjustable gastric band surgery, but less than laparoscopic sleeve gastrectomy and [Roux-en-Y gastric bypass], which produce between 60 [to] 90% [excess weight loss] at 1 year. In addition to weight loss, ESG is associated with impairment of gastric emptying, increased satiation and metabolic effects that are potentially important to control the metabolic dysregulation associated with obesity,” the researchers wrote.
Disclosures: Abu Dayyeh reports he is a consultant and received research support from Apollo Endosurgery. Please see the full study for a list of all other authors relevant financial disclosures.