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Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it?

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Abstract

Introduction

ESG is an effective treatment for classes I and II obesity. However, the benefit of ESG in patients with morbid obesity (BMI ≥ 40 kg/m2) who decline surgery is not known. The study aims to compare the effectiveness and safety of ESG in all three obesity classes at 1 year.

Methods

We reviewed 484 patient records and identified 435 patients (class I: 105, class II: 169, class III: 161) who underwent ESG at our unit between May 2013 and March 2020. We compared their total body weight loss (%TBWL) and safety over 1 year. We used a linear mixed model (LMM) to analyse repeated measures of weight loss outcomes at 3, 6, 9, and 12 months for comparison between the three BMI groups.

Results

Among the 435 patients, 396 patients (class I: 99, class II: 151, class III: 146) completed 6 months, and 211 patients reached 1 year (class I: 50, class II: 77, class III: 84). There was no difference in age between the groups. In LMM analysis, adjusting for age and sex, we found ESG had a significantly higher TBWL, %TBWL, and BMI decline in class III compared to classes I and -II obesity at all time points (p < 0.001). The adjusted mean %TBWL at 1 year with classes I, -II, and -III obesity was 16.5%, 18.2%, and 20.5%, respectively. The overall complication rate and the hospital stay was identical in the three groups.

Conclusion

ESG induced significant weight loss in all classes of obesity. In class III obesity, the weight loss achieved was significantly higher at 1 year. In patients declining or unsuitable for surgery, ESG could be considered as an alternative treatment option.

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Abbreviations

ESG:

Endoscopic sleeve gastroplasty

LSG:

Laparoscopic sleeve gastrectomy

TBWL:

Total body weight loss

EWL:

Excess weight loss

BMI:

Body mass index

SD:

Standard deviation

CI:

Confidence interval

LMM:

Linear mixed model

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Funding

No grant support was obtained for this study.

Author information

Authors and Affiliations

  1. Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 28050, Madrid, Spain

    Gontrand Lopez-Nava, Janese Laster, Anuradha Negi, I. Bautista-Castaño & Ravishankar Asokkumar

  2. Health Service Research Unit, Singapore General Hospital, Singapore, Singapore

    Stephanie Fook-Chong

  3. Ciber of Obesity and Nutrition Pathophysiology (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    I. Bautista-Castaño

  4. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore

    Ravishankar Asokkumar

  5. Duke-NUS Graduate Medical School, Singapore, Singapore

    Ravishankar Asokkumar

Authors
  1. Gontrand Lopez-Nava
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  2. Janese Laster
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  3. Anuradha Negi
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  4. Stephanie Fook-Chong
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  5. I. Bautista-Castaño
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  6. Ravishankar Asokkumar
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Contributions

GLN: conceptualized and designed the study; JL: drafted the manuscript; IB: acquired the data; AN: critically revised the manuscript; SFC: analysed and interpreted the data; IB: contributed to the endoscopy data; RA: designed the study, analysed the data and drafted the manuscript. Writing Assistance: no writing assistance obtained for this manuscript.

Corresponding author

Correspondence to Ravishankar Asokkumar.

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Disclosures

Dr. Gontrand Lopez-Nava Consultant for Apollo Endosurgery, USA; USGI Medical, USA; Nitinotes Surgical, Israel. Janese Laster, Anuradha Negi, Stephanie Fook-Chong, Inmaculada Bautista-Castaño, and Ravishankar Asokkumar have no conflict of interest or financial ties to disclose.

Ethical approval

The study was conducted following the good clinical practice guidelines and adhered to the recommendation of the Declaration of Helsinki. The Institutional Review Board approved the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Lopez-Nava, G., Laster, J., Negi, A. et al. Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it?. Surg Endosc 36, 352–360 (2022). https://doi.org/10.1007/s00464-021-08289-1

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  • DOI: https://doi.org/10.1007/s00464-021-08289-1

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