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Less weight loss, adverse events with endoscopic sleeve gastroplasty
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Patients who underwent endoscopic sleeve gastroplasty lost less weight in the first six months following surgery than patients who underwent a common laparoscopic procedure, according to research published in Gastrointestinal Endoscopy.
However, Vivek Kumbhari, MD, director of endoscopy at Johns Hopkins Bayview Medical Center, and colleagues found that the endoscopic procedure caused less adverse events and new onset GERD than laparoscopic sleeve gastrectomy (LSG).
“Because bariatric surgery is an elective procedure, even rare serious adverse events are disconcerting and can make LSG less desirable,” they wrote. “This leaves a large unmet need that could be addressed with endoscopic bariatric therapies (EBTs) such as endoscopic sleeve gastroplasty (ESG).”
Kumbhari and colleagues reviewed data from patients who underwent ESG or LSG at a single center. Researchers matched 54 patients who underwent ESG to 83 patients who underwent LSG by age, sex, and BMI and calculated percentage of body weight lost after recording patients’ weight at one month and six months following their procedure.
After six months, the percentage of total body weight lost was significantly lower in the ESG group compared with the LSG group (17.1% ± 6.5 vs. 23.6% ± 7.6; P < .01). A higher percentage of patients in the LSG group also achieved more than 15% total body weight lost (88.57% vs. 72.2%).
In checking for adverse events, Kumbhari and colleagues found a significantly lower rate among the ESG patients (5.2% vs. 16.9%; P < .05). None of the ESG patients experienced an adverse event in the hospital, while three experienced adverse events that required readmission, including for upper gastrointestinal bleeding (UGIB) and perigastric inflammatory fluid collection.
Four patients in the LSG group experienced an adverse event during their initial hospital stay, while eight had to be readmitted to the hospital because of adverse events including dehydration, abdominal pain, nausea and vomiting, UGIB and acute pancreatitis.
New-onset GERD was also less common in the ESG cohort (1.9% vs. 14.5%; P < .05).
Kumbhari and colleagues wrote that as medicine becomes more personalized, additional factors — like adverse events and cost — come into play in selecting a weight loss procedure.
“Although LSG remains superior in terms of weight lost and resolution of obesity-related comorbidities, ESG is minimally invasive, lower risk, less costly, and does not appear to contribute to the development of postoperative GERD,” they wrote. “With improvement in techniques and weight loss outcomes of EBTs such as ESG, it will become imperative for bariatric surgeons and bariatric endoscopists to work together to better define which procedure is preferable for different groups of patients.” – by Alex Young
Disclosures: Kumbhari reports financial ties to Apollo Endosurgery, Boston Scientific, Medtronic and Reshape Lifesciences . Please see the full study for all other authors’ relevant financial disclosures.
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