Introduction

Endoscopic Gastroplasty (EG) is an endoscopic therapy focusing on gastric body remodeling to treat obese patients. Nowadays three different techniques are mainly described in literature: endoscopic sleeve gastroplasty (ESG) with an overstitch endoscopic suturing device, endoluminal vertical gastroplasty (EVG) with a triangulation platform and endoluminal suturing device, and distal primary obesity surgery endoluminal (POSE-2) with an endoscopic plication system.

Aims & Methods

Our study aimed to assess changes in weight loss of these three EG techniques at 6 months follow-up, looking at some useful parameters which could predict these changes. This was a single center, randomized study (ClinicalTrials.gov NCT04854317) of patients who underwent EG (through ESG performed by Apollo Overstitch Sx, or EVG performed by Endomina, or gastric plication performed by POSE-2) for the treatment of obesity. Outcomes included the efficacy of the three EG procedures at inducing weight loss, measured by the percentage of Total Body Weight Loss (%TBWL) and Excess Weight Loss (%EWL).

Results

Between July 2020 and October 2021, 90 obese (body mass index 36.6 ± 3.1 kg/m2) patients (mean age, 46 ± 10 years; females 87.5%; obesity class II as the main obesity class in 58.3% cases; hepatic steatosis as the main comorbidity with a 70% frequency) underwent EG through ESG or EVG or POSE2. At 6 months, 63/90 (70%) patients attended their follow-up visit. They experienced 16% ± 6% TBWL and 39.7% ± 14.9% EWL, with no significant difference among the three techniques in both of parameters (p>0.62 in TBWL and p>0.94 in EWL ANOVA tests). Sixty out of sixty-three (95.2%) patients achieved at least 5% TBWL, and 54/63 (85.7%) achieved at least 25% EWL. All the body circumferences homogeneously decreased (p<0.001). By a linear regression analysis, at 6 months follow-up a significant correlation between the Phase Angle and the %TBWL (p<0.05) and %EWL (p<0.05) was detected.

Conclusion

Our study confirms that ESG, EVG and POSE-2 are valuable EG procedures to reduce weight in obese patients. The Phase Angle could be considered a useful predictor of weight loss after the EG, at least in the short-term. Detecting valuable predictors of weight loss could be helpful not only in the post-operative, but also and mainly in the pre-operative to tailor a specific intervention for each patient according to the emerging concept of personalized therapy for obesity. Further studies with more patients and a longer follow-up are needed to confirm our data.

Disclosure

Consultant of: Apollo Endosurgery, USGI Medical, Endotools.

Introduction

With the global rise in obesity, endoscopic bariatric therapy (EBT) is increasingly adopted as a less invasive alternative to surgery. Among the most commonly used approaches are space-occupying techniques via intragastric balloons (IGB) and restrictive methods like endoscopic gastroplasty (EG).

Aims & Methods

This study aimed to evaluate changes in anthropometric parameters and body composition following EBT, and to identify early predictors of weight loss associated with these procedures. This analysis combined data from two single-center, randomized trials involving obese patients undergoing EBT using either IGB (ClinicalTrials.gov NCT06673550) or EG (ClinicalTrials.gov NCT04854317). The primary outcome was the effect of EBT on body circumferences (arm, waist, hip, calf) and body composition metrics including fat mass (FM), fat-free mass (FFM), and body cell mass (BCM). The secondary outcome focused on identifying predictive factors for weight loss. The 6-month follow-up was chosen for assessment, corresponding to the standard IGB removal timeline.

Results

Between July 2020 and January 2024, 318 obese patients were included: 156 received IGB (mean age 46±14 years; 69.2% female; mean BMI 41.9±9.1 kg/m²; 53.0% with class III obesity), while 162 underwent EG (mean age 46±10 years; 87.5% female; mean BMI 36.6±3.1 kg/m²; 58.3% with class II obesity). Follow-up at 6 months was completed by 93.5% in the IGB group (146/156) and 70.4% in the EG group (114/162). Average total body weight loss (TBWL) was 14.2±7.1% for IGB and 16±6% for EG, with corresponding excess weight loss (EWL) of 30.8±23.3% and 39.7±14.9%, respectively. Both groups showed significant reductions in all body circumferences (p<0.001). FM and FM% decreased markedly (p<0.001), while FFM% (p<0.001) and BCM% (p<0.05) increased. In the EG group, linear regression revealed a significant correlation between phase angle and both TBWL (r=0.327, p<0.05) and EWL (r=0.274, p<0.05), a relationship not observed in the IGB group. This difference may be due to distinct baseline characteristics, particularly BMI, and the differing mechanisms of action between the two EBT modalities.

Conclusion

Both IGB and EG demonstrated effectiveness in promoting weight loss, reducing body measurements, and improving body composition in obese patients. Phase angle may serve as a valuable predictor of weight loss in certain EBT approaches, suggesting its potential role in guiding personalized obesity treatment strategies.

Disclosure

Dr Vadalà di Prampero and Dr Milutin Bulajic are consultants for Apollo Endosurgery, EndoTools Therapeutics and USGI Medical.

Introduction

Endoscopic Gastroplasty (EG) is an endoscopic therapy focusing on gastric body emodeling to treat obese patients. Nowadays three different techniques are mainly described in literature: endoscopic sleeve gastroplasty (ESG) with an overstitch endoscopic suturing device, endoluminal vertical gastroplasty (EVG) with a triangulation platform and endoluminal suturing device, and distal primary obesity surgery endoluminal (POSE-2) with an endoscopic plication system.

Aims & Methods

Our study aimed to assess changes in anthropometric measurements (AM), body composition (BC) and quality of life (QoL) of these three EG techniques at 6 months follow-up. This was a single center, randomized study (ClinicalTrials.gov NCT04854317) of patients who underwent EG (through ESG performed by Apollo Overstitch Sx, or EVG performed by Endomina, or gastric plication performed by POSE-2) for the treatment of obesity. Outcomes included the efficacy of the three EG procedures at inducing weight loss, improving body circumferences (arm, waist, hip and calf), BC (fat mass (FM), free fat mass (FFM), body cell mass (BCM)), and QoL.

Results

Between July 2020 and October 2021, 90 obese (body mass index 36.6 ± 3.1 kg/m2) patients (mean age, 46 ± 10 years; females 87.5%; obesity class II as the main obesity class in 58.3% cases; hepatic steatosis as the main comorbidity with a 70% frequency) underwent EG through ESG or EVG or POSE-2. At 6 months, 63/90 (70%) patients attended their follow-up visit. They experienced 16% ± 6% total body weight loss (TBWL) and 39.7% ± 14.9% excess weight loss (EWL). Sixty out of sixty-three (95.2%) patients achieved at least 5% TBWL, and 54/63 (85.7%) achieved at least 25% EWL. All the body circumferences homogeneously decreased (p<0.001). Concerning BC, the FM and FM% significantly decreased (p<0.001), while the FFM% and BCM% increased (p<0.01). The QoL measured by BAROS test improved at 6-month follow-up (p<0.01).

Conclusion

EG through ESG, EVG and POSE-2, focusing on gastric body reduction and sparing the fundus and antrum, appears to be effective for the treatment of obese patients inducing weight loss and improving the other AM, BC and QoL.

Disclosure

Consultant of: Apollo Endosurgery, USGI Medical, Endotools.

Introduction

Aims & Methods

Results

Conclusion

Disclosure

Introduction

Obesity, one of the most common co-morbidities in women of reproductive age, contributes to infertility and obesity-related pregnancy complications. On the other hand, pregnancy is a condition in which, physiologically, the pregnant woman undergoes weight gain. Endoscopic Sleeve Gastroplasty (ESG), an organ-sparing bariatric procedure aimed to reduce gastric volume and modify gastric motility with full-thickness endoscopic sutures, may be used for the treatment of obesity in women of childbearing age.

Aims & Methods

A retrospective analysis of a prospective database was conducted to evaluate weight trajectories, the evolution of obesity-related comorbidities, and lifestyle modification in women who became pregnant after ESG.
A comparison was made between childbearing-age women who became pregnant after ESG and non-pregnant women who reached at least the 6-month follow-up after ESG.

Results

Between January 2018 and December 2021, a total of 150 childbearing-age women underwent ESG at a large Italian tertiary medical center. Out of the total, 18 patients (12,0 %) reported a desire for pregnancy associated with unsuccessful attempts in the 12 months preceding ESG.
Eleven patients (mean age 33,4±6,2 years) became pregnant after the procedure, following a mean time interval of 5,5±3,9 months. The mean preconception BMI was 31,9±4,0 kg/m² (with a mean reduction of 7,24±4,0 kg/m² after ESG). Three patients were affected by hyperinsulinemia (H-INS), while an additional patient had both H-INS and high blood pressure (HBP). Three women reported difficulty in becoming pregnant before the ESG: two were affected by PCOS.
Total body weight loss (TBWL) of at least 5% was achieved before pregnancy in all patients (73% reached a TBWL ≥ 10%).
Six out of eleven (55%) patients had weight gain in the ranges recommended by the Institute of Medicine (IOM) during pregnancy. Among the 18 women with a reported desire for maternity associated with difficult attempts in the previous 12 months, 16,6 % (3/18) managed to start and carry out a pregnancy.
TBWL (%) was 18,08±8,00, 10,35±11,53, and 12,08±8,49, at the beginning of pregnancy, at the delivery, and at the first follow-up (mean interval, 5,18±3,57 months).
No significant differences in WL, TBWL, EWL, BMI, BAROS, and QoL were found between the pregnancy and non-pregnancy groups (99 childbearing-age women) up to 24 months after ESG.

Conclusion

ESG produces adequate weight loss before pregnancy in patients with obesity and is potentially a useful treatment option for women who have difficulty becoming pregnant, such as those with PCOS. Pregnancy after ESG does not adversely affect weight loss outcomes after delivery as lifestyle changes induced by ESG are maintained after pregnancy and allow for a gradual loss of weight gained during pregnancy.