Gastrointestinal endoscopy | 2019
Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study.
Abstract
BACKGROUND AND AIMS\nObesity is a pandemic effecting approximately 700 million adults worldwide with an additional 2 billion overweight. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric therapy that involves remodeling of the greater curvature, in an effort to reduce gastric capacity and delay gastric emptying. A variety of ESG suture patterns have been reported. This study is the first to use a uniform U stitch pattern across all centers to simplify technical aspects of the procedure and limit cost. This also uniquely assessed outcomes in all BMI categories and changes in metabolic rate, lean body mass, and adipose tissue composition.\n\n\nMETHODS\nThis is a multicenter analysis of prospectively collected data from 7 centers including patients with overweight and obesity who underwent ESG. Primary outcomes included AWL, %TWL, change in BMI, %EWL at 6 and 12 months in overweight, obese class I, II, and III. Secondary outcomes included adipose tissue, lean body mass reduction, and metabolic rate analyzed by bioimpedance. Additionally, immediate or delayed adverse events were analyzed. Clinical success was defined as achieving ≥25% EWL at 1 year with ≤ 5% serious adverse event rate following the ASGE/ASMBS threshold.\n\n\nRESULTS\nA total of 193 patients underwent ESG during the study period. All groups had >10% TWL and >25% EWL at 6 months follow-up. On avarage, %TWL was 14.25% ± 5.26 and 15.06% ± 5.22 and the %EWL was 56.15% ± 22.93 and 59.41% ± 25.69 at 6 months and 1-year follow-up, respectively. %TWL was 8.91%±0.3, 13.92%±5.76, 16.22%±7.69, and 19.01%±0.95, and %EWL was 56.21%±2.0, 62.03%±27.63, 54.13%±23.46, and 46.78%±2.43 for overweight, obesity class I, II, and III, respectively, at 1 year. Male, age <41 years old, and higher BMI are predictors of achieving a TWL ≥10% at 1-year follow-up. There was a significant reduction in adipose tissue from baseline. Severe adverse events occurred in 1.03% including 2 perigastric collections needing surgery.\n\n\nCONCLUSION\nEndoscopic sleeve gastroplasty appears to be feasible, safe, and effective in the treatment of patients with overweight and obesity according to the ASGE/ASMBS thresholds.