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Obesity Surgery

, Volume 27, Issue 10, pp 2649–2655 | Cite as

Endoscopic Sleeve Gastroplasty for Obesity: a Multicenter Study of 248 Patients with 24 Months Follow-Up

  • Gontrand Lopez-Nava
  • Reem Z. Sharaiha
  • Eric J. Vargas
  • Fateh Bazerbachi
  • Galvao Neto Manoel
  • Inmaculada Bautista-Castaño
  • Andres Acosta
  • Mark D. Topazian
  • Manpreet S. Mundi
  • Nikhil Kumta
  • Michel Kahaleh
  • Andrea Marie Herr
  • Alpana Shukla
  • Louis Aronne
  • Christopher J. Gostout
  • Barham K. Abu Dayyeh
Original Contributions

Abstract

Background

Endoscopic sleeve gastroplasty (ESG) is a technique for managing mild to moderately obese patients. We aimed to evaluate the long-term outcomes, reproducibility, and predictors of weight response in a large multicenter cohort.

Methods

Patients who underwent ESG between January 2013 and December 2015 in three centers were retrospectively analyzed. All procedures were performed using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). We performed per protocol (PP) and intention-to-treat (ITT) analyses, where patients lost to follow-up were considered failures. Multivariable linear and logistic regression analyses were performed.

Results

We included 248 patients (mean age 44.5 ± 10 years, 73% female). Baseline BMI was 37.8 ± 5.6 kg/m2. At 6 and 24 months, 33 and 35 patients were lost to follow-up, respectively. At 6 and 24 months, %TBWL was 15.2 [95%CI 14.2–16.3] and 18.6 [15.7–21.5], respectively. Weight loss was similar between centers at both follow-up intervals. At 24 months, % of patients achieving ≥10% TBWL was 84.2 and 53% with PP and ITT analyses, respectively. On multivariable linear regression analysis, only %TBWL at 6 months strongly predicted %TBWL at 24 months (adjusted for age, gender, and baseline BMI, β = 1.21, p < 0.001). The odds of achieving ≥10%TBWL at 24 months if a patient achieved <10%TBWL at 6 months is 0.18 [0.034–0.84]. Five (2%) serious adverse events occurred.

Conclusions

ESG effectively induces weight loss up to 24 months in moderately obese patients. Failure to achieve adequate weight loss can be predicted early, and patients should be offered adjunctive therapies to augment it.

Keywords

Gastric restriction Stomach Weight loss procedure Endoscopic 

Notes

Compliance with Ethical Standards

Conflict of Interest

Authors 1, 2, 5, and 16 are consultants for Apollo Endosurgery (Austin, TX).

Author 15 is the chief medical officer for Apollo Endosurgery (Austin, TX).

All other authors have nothing to disclose.

Statement of Informed Consent

Informed consent was obtained from all individuals undergoing all procedures and included in our study. No identifying information is included in our study.

Statement of Ethical Rights and Human Rights (as No Animal Experiments Were Conducted in this Study)

All procedures performed in our study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

References

  1. 1.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Acosta A, Abu Dayyeh BK, Port JD, et al. Recent advances in clinical practice challenges and opportunities in the management of obesity. Gut. 2014;63(4):687–95.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & bariatric surgery. Surg Obes Relat Dis. 2013;9(2):159–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Bazerbachi F, Vargas Valls EJ, Abu Dayyeh BK. Recent clinical results of endoscopic bariatric therapies as an obesity intervention. Clinical endoscopy. 2017;50(1):42–50.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Force ABET, Committee AT, Abu Dayyeh BK, et al. Endoscopic bariatric therapies. Gastrointest Endosc. 2015;81(5):1073–86.CrossRefGoogle Scholar
  6. 6.
    Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc. 2013;78(3):530–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Sharaiha RZ, Kedia P, Kumta N, et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy. 2015;47(2):164–6.PubMedGoogle Scholar
  8. 8.
    Lopez-Nava G, Galvao MP, da Bautista-Castano I. Jet al. Endoscopic sleeve gastroplasty for the treatment of obesity. Endoscopy. 2015;47(5):449–52.PubMedGoogle Scholar
  9. 9.
    Lopez-Nava G, Galvao MP, Bautista-Castano I, et al. Endoscopic sleeve gastroplasty: how I do it? Obes Surg. 2015;25(8):1534–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Lopez-Nava Breviere G, Bautista-Castano I, Fernandez-Corbelle JP, et al. Endoscopic sleeve gastroplasty (the Apollo method): a new approach to obesity management. Rev Esp Enferm Dig. 2016;108(4):201–6.PubMedGoogle Scholar
  11. 11.
    Galvao-Neto MD, Grecco E, Souza TF, et al. Endoscopic sleeve gastroplasty—minimally invasive therapy for primary obesity treatment. Arq Bras Cir Dig. 2016;29(Suppl 1):95–7.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Kumar N, Lopez-Nava G, Sahdala HNP, et al. Endoscopic sleeve gastroplasty: multicenter weight loss results. Gastroenterology. 2015;148(4):S179.CrossRefGoogle Scholar
  13. 13.
    Abu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2017;15(1):37–43.e1.CrossRefGoogle Scholar
  14. 14.
    Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc. 2013;78(3):530–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Wadden TA, Neiberg RH, Wing RR, et al. Four-year weight losses in the look AHEAD study: factors associated with long-term success. Obesity (Silver Spring). 2011;19(10):1987–98.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–78.e5.CrossRefPubMedGoogle Scholar
  17. 17.
    Daniel S, Soleymani T, Garvey WT. A complications-based clinical staging of obesity to guide treatment modality and intensity. Curr Opin Endocrinol Diabetes Obes. 2013;20(5):377–88.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424–34.CrossRefPubMedGoogle Scholar
  19. 19.
    Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.CrossRefPubMedGoogle Scholar
  20. 20.
    van de Laar A, de Caluwe L, Dillemans B. Relative outcome measures for bariatric surgery. Evidence against excess weight loss and excess body mass index loss from a series of laparoscopic Roux-en-Y gastric bypass patients. Obes Surg. 2011;21(6):763–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Action for Health in Diabetes Study G. Association of weight loss maintenance and weight regain on 4-year changes in CVD risk factors: the action for health in diabetes (Look AHEAD) clinical trial. Diabetes Care. 2016;39(8):1345–55.CrossRefGoogle Scholar
  22. 22.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.CrossRefPubMedGoogle Scholar
  23. 23.
    Abu Dayyeh BK, Edmundowicz SA, Jonnalagadda S, et al. Endoscopic bariatric therapies. Gastrointest Endosc. 2015;81(5):1073–86.CrossRefPubMedGoogle Scholar
  24. 24.
    Courcoulas A, Dayyeh BA, Eaton L, et al. Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial. International journal of obesity. 2016.Google Scholar
  25. 25.
    Ponce J, Woodman G, Swain J, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2015;11(4):874–81.CrossRefGoogle Scholar
  26. 26.
    Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597–604.CrossRefPubMedGoogle Scholar
  27. 27.
    MacLean PS, Wing RR, Davidson T, et al. NIH working group report: innovative research to improve maintenance of weight loss. Obesity. 2015;23(1):7–15.CrossRefPubMedGoogle Scholar
  28. 28.
    Mor A, Sharp L, Portenier D, et al. Weight loss at first postoperative visit predicts long-term outcome of Roux-en-Y gastric bypass using Duke weight loss surgery chart. Surg Obes Relat Dis. 2012;8(5):556–60.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Sharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clinical Gastroenterology and Hepatology. 2016.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Gontrand Lopez-Nava
    • 1
  • Reem Z. Sharaiha
    • 2
  • Eric J. Vargas
    • 3
  • Fateh Bazerbachi
    • 3
  • Galvao Neto Manoel
    • 4
  • Inmaculada Bautista-Castaño
    • 1
  • Andres Acosta
    • 3
  • Mark D. Topazian
    • 3
  • Manpreet S. Mundi
    • 5
  • Nikhil Kumta
    • 2
  • Michel Kahaleh
    • 2
  • Andrea Marie Herr
    • 2
  • Alpana Shukla
    • 2
  • Louis Aronne
    • 6
  • Christopher J. Gostout
    • 3
  • Barham K. Abu Dayyeh
    • 3
  1. 1.Bariatric Endoscopy UnitMadrid Sanchinarro University HospitalMadridSpain
  2. 2.Department of GastroenterologyWeill Cornell MedicineNew YorkUSA
  3. 3.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  4. 4.Department of SurgeryFlorida International University Herbert Wertheim College of MedicineMiami BeachUSA
  5. 5.Division of EndocrinologyMayo ClinicRochesterUSA
  6. 6.Department of EndocrinologyWeill Cornell MedicineNew YorkUSA

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