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Endoscopic sleeve offers effective alternative to bariatric surgery
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CHICAGO — Endoscopic sleeve gastroplasty, a technique that pleats the stomach with sutures, offers an effective weight-loss alternative to patients who are not candidates for more intensive bariatric surgery.
“These results support the conclusion that the less invasive option — endoscopic sleeve gastroplasty — is a safe and effective treatment, especially for patients for whom surgical options are not possible for one reason or another,” Reem Z. Sharaiha, MD, gastroenterologist at Weill Cornell Medicine and NewYork-Presbyterian, said in a pre-meeting press briefing.
Reem Z. Sharaiha
Endoscopic sleeve gastroplasty (ESG) creates pleats in the stomach to create a feeling of fullness and reduce stomach volume, Sharaiha explained.
Sharaiha and colleagues compared patients who underwent ESG (n = 91) to laparoscopic sleeve gastrectomy (n = 120) and laparoscopic banding (n = 67) who had 1 year of follow-up at an academic bariatric center of excellence.
After 1 year of follow-up, the ESG group saw 17.57% weight loss as compared to 29.28% in laparoscopic sleeve gastrectomy and 14.46% in the laparoscopic banding group, she said.
“While endoscopic sleeve gastroplasty patients did not achieve the greatest amount of weight loss, they achieve by far the lowest grade of medical complication,” with just 1% vs. 10% with laparoscopic sleeve and 11% for laparoscopic banding, Sharaiha said.
The “vast majority” of patients who underwent ESG left the hospital the same day while those who had laparoscopic sleeve stayed for 3 days and those who had laparoscopic banding stayed approximately a day and a half.
ESG also cost less than the other procedures at an average of $12,000 vs. $22,000 for laparoscopic sleeve and $15,000 for laparoscopic banding, Sharaiha said.
While all patients with a BMI greater than 40 are often recommended for surgical weight loss procedures, only 2% of eligible individuals undergo surgery, Sharaiha said. She added that ESG would be appropriate for most patients who have a contraindication or for those patients with BMI between 30 and 40.
“We are not suggesting that endoscopic approach should not replace the two surgical options. Instead, these results show that endoscopic sleeve gastroplasty is another safe and reliable cost effective option among many options for weight management available these days,” Sharaiha said. – by Katrina Altersitz
Reference: Novikov A, et al. Abstract 334. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
Disclosures: Sharaiha reports a financial relationship with Boston Scientific.
Perspective
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Barham K. Abu Dayyeh, MD, MPH
Dr. Novikov and colleagues from Weill Cornell Medical Center presented an important abstract during DDW entitled “Endoscopic Sleeve Gastroplasty, Laparoscopic Sleeve Gastrectomy, and Laparoscopic Band for Weight Loss, How do They Compare.” In this abstract, they compared the efficacy, safety, and cost of two bariatric surgical interventions (LSG and LAGB) to a new endoscopic option (ESG).
At 12 months, LSG was superior to both LAGB and ESG; however, ESG was the lowest cost and had the most favorable safety profile among the three interventions.This excellent abstract demonstrates the evolution of a spectrum of care for patients with obesity to include minimally invasive (non-surgical) endoscopic procedures that will finally fill the management gap between medical and surgical options for the treatment of obesity and associated co-morbidities.
Examples of successful implementation of similar spectrums of care to include minimally invasive procedural options are ample in the field of medicine and have revolutionized the approach to patient with cardiac problems, for example. Nowadays, a diseased aortic valve of the heart can be fixed through the blood vessels, as opposed to valve replacement by open heart surgery.
We know that anatomic surgical manipulations of the gastrointestinal tract results in successful and durable weight loss and metabolic improvement; thus, the logical progression to attempt to replicate these anatomic manipulations in a minimally invasive and less costly fashion as demonstrated in this abstract is overdue and greatly needed. This will offer patients with obesity multiple medical, endoscopic, and surgical option to fit their individual physiology, medical needs, and preference.
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