Introduction

Obesity is a chronic and recurrent disease. In the past few years, Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive technique to fill the therapeutic gap between medical and surgical approaches to obesity. ESG consists of full-thickness suturing of the gastric body to restrict gastric volume and impair gastric motility. Most of the published data on ESG are limited to 12-24 months^1-6. In this study, we aim to report long-term results of ESG to implement further the evidence of long-term effectiveness in each BMI class.

Aims & Methods

A post-hoc analysis was performed on a prospective database including patients with obesity (BMI ≥ 30 kg/m²) who underwent ESG between May 2017 and May 2021 at a single tertiary Center. Before ESG, all patients were evaluated and identified as eligible for the bariatric procedure by the local bariatric multidisciplinary team. Weight loss outcomes (%EWL, %TBWL) were evaluated during follow-up and stratified according to obesity class. We evaluated the percentage of patients achieving %EWL>25%, the current threshold defining the efficacy of a primary bariatric endoscopic procedure^​7, as well as percentage of patients achieving %TBWL>10%, the minimum threshold associated with obesity-related comorbidities improvement⁸. All patients were included in a multidisciplinary follow-up scheduled at 1, 3, 6, and then every 6 months, as per routine clinical practice.

Results

Between May 2017 and May 2021, 252 subjects (73% Female) underwent ESG with a median BMI of 37.2 (35.3-40.8) kg/m² at baseline and a median age of 45 (36-54) years. No severe procedure-related adverse events occurred. Of 252 subjects, 58 (23%) had obesity class I (BMI 30-34.9), 120 (48%) had obesity class II (BMI 35-39.9), and 74 (29%) had class III obesity (BMI ≥ 40). Follow-up rate was 90.5% (228/252) at 12 months, 60.3% (152/252) at 24 months, and 30.2% at 30-36 months. Overall, 58% (44/76) of patients showed an %EWL>25% at 30-36 months of follow-up, respectively. Similarly, 71% (54/76) of subjects showed a %TBWL> 5% 30-36 months after ESG. Weight loss results according to BMI class are reported in Table 1.

Conclusion

Despite limited by the follow-up loss, a common issue in clinical pratice for obesity cohorts, our experience confirms that ESG in the setting of a multidisciplinary approach is a safe and effective procedure for the treatment of obesity, associated with sustained weight loss in all obesity classes.

References

1. Sharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2017;15(4):504-510.
2. Lopez-Nava G, Sharaiha RZ, Vargas EJ, et al. Endoscopic Sleeve Gastroplasty for Obesity: a Multicenter Study of 248 Patients with 24 Months Follow-Up. Obes Surg. 2017;27(10):2649-2655.
3. Graus Morales J, Crespo Pérez L, Marques A, et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc. 2018;32(9):3936-3942.
4. Alqahtani A, Al-Darwish A, Mahmoud AE, Alqahtani YA, Elahmedi M. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc. 2019;89(6):1132-1138.
5. Sharaiha RZ, Hajifathalian K, Kumar R, et al. Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity. Clin Gastroenterol Hepatol. 2021;19(5):1051-1057.e2.
6. Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet Lond Engl. 2022;400(10350):441-451.
7. Ginsberg GG, Chand B, Cote GA, et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc. 2011;74(5):943-953.
8. Ryan DH, Yockey SR. Weight Loss and Improvement in Comorbidity: Differences at 5%,10%,15%, and Over. Curr Obes Rep. 2017;6(2):187-194.

Clinical Case Summary

Colonoscopy is an essential tool in the diagnosis and management of various gastrointestinal disorders, yet it carries a risk of complications that can complicate patient care. Among these, post-colonoscopy appendicitis represents a rare but critical condition. The interplay between colonoscopy-induced inflammation and pre-existing appendiceal pathology may contribute to this phenomenon. A thorough understanding of the pathophysiology, clinical manifestations, and management strategies associated with post-colonoscopy appendicitis is vital for healthcare professionals to enhance early recognition and optimize patient outcomes.
A sixty-one-year-old female patient underwent esophagogastroduodenoscopy(EGD) and colonoscopy due to recurrent episodes of diffuse, non-radiating mild abdominal pain, as well as for colorectal cancer screening. The procedure was conducted without complications, but the bowel preparation was deemed inadequate (BBPS: 1-2-1). Twenty-four hours later, the patient presented to the emergency department, reporting severe diffuse non-radiating abdominal pain accompanied by multiple episodes of vomiting, nausea, and watery non-bloody diarrhea. Computed tomography of the abdomen was performed showing acute appendicitis. Subsequently, open appendectomy was performed with a course of intravenous antibiotics and patient then discharged home in good physical condition.
In conclusion, this case highlights the potential for post-colonoscopy appendicitis as a rare but significant complication that can arise following gastrointestinal procedures. It underscores the importance of maintaining a high index of suspicion for appendicitis in patients presenting with abdominal symptoms after colonoscopy, facilitating timely diagnosis and treatment.

References

• Ali,Mohammad MD¹; Patel, Jigar MD²; Katz, Douglas MD²; Friedel, David MD³. Post-Colonoscopy Appendicitis: A Rare but Concerning Entity: 1548. American Journal of Gastroenterology 113():p S891, October 2018
• ASGE review of adverse events in colonoscopyKothari, Shivangi T. et al.
  Gastrointestinal Endoscopy, Volume 90, Issue 6, 863 - 876.e3