Minimally invasive endoscopic sleeve gastroplasty significantly reduces BMI, metabolic complications

By Liz Meszaros, MDLinx
Published April 21, 2017

Key Takeaways

Endoscopic sleeve gastroplasty (ESG)—a minimally invasive bariatric procedure that reduces the length and width of the gastric cavity to aid in weight loss and requires no incision—is an effective and safe weight-loss intervention in some obese patients, effecting sustained total body weight loss up to 24 months, and reducing markers of hypertension, diabetes, and hypertriglyceridemia, according to researchers from NewYork-Presbyterian and Weill Cornell Medicine.

They published their results online in the Spring 2017 issue of Clinical Gastroenterology and Hepatology.

“Obesity is a significant health concern that affects millions of people across the country, but until now there hasn’t been an effective minimally invasive treatment we could offer patients,” said lead author Reem Sharaiha, MD, MSc, director of bariatric endoscopy and associate director of the Pancreas Program, NewYork-Presbyterian/Weill Cornell Medical Center, and an assistant professor of medicine at Weill Cornell Medicine, New York, NY. “With ESG, we’re giving patients who are eligible for surgery, or deemed to be too high risk for surgery, a new option for their care.”

Dr. Sharaiha and colleagues included 91 consecutive patients with a mean age of 43 years (68% female) who underwent ESG from August 2013 through March 2016. All patients had a BMI of greater than 30 kg/m2 and had failed noninvasive weight-loss attempts or had a BMI greater than 40 mg/m2 who were not eligible for, or refused, surgery.

ESG is performed using an endoscope, with the goal of reducing both the length and width of the stomach. For this study, researchers used a cap-based flexible endoscopic suturing system in all cases to achieve a triangular suture pattern to imbricate the greater curvature of the stomach.

At 6 months (n=73), 12 months (n=53), and 24 months (n=12), patients were evaluated for anthropometric features including BMI, weight, waist circumference, and blood pressure, and serologic tests, lipid panels, serum triglycerides, and liver function testing.

The primary outcome of the study was total body weight loss at 6, 12, and 24 months, and secondary outcomes included effects on metabolic factors, including blood pressure, diabetes, hyperlipidemia, and steatohepatits; and safety. Preoperative mean BMI was 40.7 kg/m2.

At 6 months, patients had lost 14.4% of their total body weight; at 12 months, 17.6%, and at 24 months, 20.9%. At 12 months, researchers found statistically significant reductions in hemoglobin A1c levels (P=0.01), systolic blood pressure (P=0.02), waist circumference (P < 0.001), alanine aminotransferase (P < 0.001), and serum triglycerides (P=0.02). They found no significant changes, however, in low-density lipoprotein (P=079).

One serious adverse event occurred—perigastric leak—that was managed non-operatively.

Dr. Sharaiha and colleagues will conduct a new, randomized, controlled trial comparing ESG to diet and exercise. They are currently recruiting patients.

Dr. Sharaiha is a consultant for Apollo Endosurgery, Inc.

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