Background:
Endoscopic bariatric techniques have emerged as effective therapies in the management of obesity. Endoscopic Sleeve Gastroplasty (ESG) is an incisionless transoral endoscopic procedure whereby a gastric luminal sleeve is fashioned by application of a series of transmural sutures placed along the greater curvature of the stomach resulting in a reduction in functional volume by approximately 75%. The study aimed to examine the efficacy and safety of ESG for weight loss.
Methods:
44 obese patients with mean age 42 years and mean body mass index 37.4 kg/m2 underwent ESG, 35 as a primary bariatric procedure and 9 as a consequent procedure after intragastric balloon placement. All procedures were conducted as day-only/outpatient cases and were provided with protocolised IV infusion support and dietitian and psychologist support post procedure. Primary outcomes included total weight loss (kg), proportion of total body weight loss (TBWL, %), excess weight loss (EWL, %), ΔBMI (kg/m2), and immediate and delayed complications at 1 and 3 months post procedure.
Results:
Total weight loss was 10.8±3.9 kg at 1 month (TBWL 10.9±2.9%; EWL 32.6±11.1%; ΔBMI 3.8±1.2) and 13.6±5.9 kg at 3 months procedure (TBWL 12.6±4.2%; EWL 40.2±15.7%; ΔBMI 4.8±1.9). Weight loss was similar in patients who underwent ESG as a primary bariatric procedure when compared to those who had previously had an intragastric balloon. Number of dietitian visits post procedure was associated with significantly greater weight loss by 3 months post-procedure (P<0.001). There were no major intraprocedural or post-procedural complications. The most commonly reported early adverse events included cramping abdominal pain (34%), nausea (18%) and reflux (18%). These were well managed by use of appropriate pharmacologic agents and resolved within the first week in 90% of patients.
Conclusion:
These results lead us to consider ESG as a safe and effective endoscopic outpatient procedure for weight loss without significant complications.