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 months1-6. 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 procedure7, 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.
| Overall | Class I Obesity | Class II Obesity | Class III Obesity |
| %EWL 12mo | 46.6 (27.9-63.2) | 49.7 (30.4-66.3) | 50.8 (32.7-64.0) | 45.2 (27.8-57.1) |
| %EWL 24mo | 39.3 (17.6-58.4) | 39.3 (18.1-58.6) | 41.5 (14.4-60.8) | 31.3 (17.5-49.3) |
| %EWL 30-36mo | 36.4 (21.0-66.3) | 31.3 (6.4-54.7) | 31.4 (13.0-54.8) | 31.4 (13.0-54.8) |
| %TBWL 12mo | 15.6 (10.3-21.3) | 12.5 (6.5-19.4) | 16.3 (10.5-22.4) | 16.2 (10.5-22.6) |
| %TBWL 24mo | 12.8 (6.4-19.4) | 15.9 (10.3-21.3) | 13.8 (4.5-18.9) | 15.1 (7.6-22.9) |
| %TBWL 30-36mo | 13.3 (6.7-23.8) | 11.1 (4.5-18.3) | 10.7 (4.4-18.2) | 10.7 (4.4-18.2)
|
| % of patients with %EWL>25% (30-36mo) | 58% (44/76) | 77% (10/13) | 68% (20/32) | 42% (13/31) |
| % of patients with %TBWL>5% (30-36mo) | 71% (54/76) | 77% (10/13) | 75% (24/32) | 61% (19/31) |
%EWL and %TBWL are reported as median (Q1-Q3)
%EWL: percentage of excess weight loss; %TBWL; percentage of total body weight loss; mo: months. |
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
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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.
