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Brazilian Consensus on Endoscopic Sleeve Gastroplasty

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Abstract

Purpose

Bariatric endoscopy is a less invasive approach for obesity management, with better efficacy than pharmacological treatment and low morbidity. Endoscopic sleeve gastroplasty (ESG) is the remodeling of the stomach using a suturing device showing technical feasibility, safety, and sustained weight loss. With growing numbers of procedures worldwide, there is a need to standardize the procedure.

Materials and Methods

A consensus meeting was held in São Caetano do Sul-SP, Brazil, in June 2019, bringing together 47 Brazilian endoscopists with experience in ESG from all regions of the country. Topics on indications and contraindications of the procedure, pre-procedure evaluation and multidisciplinary follow-up, technique and post-procedure follow-up, and training requirements were discussed. An electronic voting was carried, and a consensus was defined as ≥ 70% agreement.

Results

The panel’s experience consisted of 1828 procedures, with a mean percentage total body weight loss (TBWL) of 18.2% in 1 year. Adverse events happened in 0.8% of the cases, the most common being hematemesis. The selected experts discussed and reached a consensus on several questions concerning patient selection, contraindications for the procedure, technical details such as patient preparation, procedure technique, and patient follow-up.

Conclusions

This consensus establishes practical guidelines for performance of ESG. The experience of 1828 procedures shows the expertise of the selected specialists participating in this consensus statement. The group’s experience has a satisfactory weight loss with low adverse events rate. The main points discussed in this paper may serve as a guide for endoscopists performing ESG. Practical recommendations and technique standardization are described.

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Author information

Authors and Affiliations

  1. Endovitta Institute, Santo Andre, Brazil

    Manoel Galvão Neto, Eduardo Grecco & Thiago Ferreira de Souza

  2. Medicine of ABC, Santo Andre, Brazil

    Manoel Galvão Neto, Luiz Gustavo de Quadros, Eduardo Grecco, Admar Concon Filho & Thiago Ferreira de Souza

  3. Federal University of Pernambuco, Recife, Brazil

    Lyz Bezerra Silva

  4. Kaiser Clinic, Sao Jose do Rio Preto, Brazil

    Luiz Gustavo de Quadros

  5. Galileo Hospital, Valinhos, Brazil

    Admar Concon Filho

  6. 9 de Julho Hospital, Sao Paulo, Brazil

    Artagnan Menezes Barbosa de Amorim

  7. Instituto Falcao de Endoscopia e Cirurgia, Salvador, Brazil

    Marcelo Falcao de Santana

  8. Hospital Rios Dor, Rio de Janeiro, Brazil

    Newton Teixeira dos Santos

  9. Endobatel Endoscopia Digestiva, Curitiba, Brazil

    Joao Henrique Felicio de Lima

  10. Digestive Center, Fortaleza, Brazil

    Helmut Wagner Poti de Morais

  11. Endodiagnostic Clinic, Rio de Janeiro, Brazil

    Felipe Matz Vieira

  12. Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA

    Rena Moon & André F. Teixeira

Authors
  1. Manoel Galvão Neto
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  2. Lyz Bezerra Silva
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  3. Luiz Gustavo de Quadros
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  4. Eduardo Grecco
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  5. Admar Concon Filho
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  6. Artagnan Menezes Barbosa de Amorim
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  7. Marcelo Falcao de Santana
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  8. Newton Teixeira dos Santos
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  9. Joao Henrique Felicio de Lima
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  10. Thiago Ferreira de Souza
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  12. Felipe Matz Vieira
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  13. Rena Moon
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  14. André F. Teixeira
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Consortia

for the Brazilian Endoscopic Sleeve Gastroplasty Collaborative

  • Adriano Tomas Vasconcelos Alexandre
  • , Leonardo Salles de Almeida
  • , Jose Rubes Arnoni
  • , Fermanda Nascimento Bueno
  • , Keila Regina Matos Cantanhebe
  • , Rafael Pasqualini de Carvalho
  • , Alexandre Cenatti
  • , Bruna Durelli
  • , Elaine Moreira Ferreira
  • , Luiz Henrique de Sousa Filho
  • , Idiberto Jose Zotarelli Filho
  • , Anna Carolina Hoff
  • , Mauro Rodrigues Coelho Jacome
  • , Muhammad Jawad
  • , Igor Marchetti
  • , Luis Augusto Matta
  • , Tulio Medeiros
  • , Luiz Henrique Mazzonetto Mestieri
  • , Marcius Vinicius de Moraes
  • , Joao de Siqueira Neto
  • , Alvaro Oliveira Neto
  • , Joffre Rezende Neto
  • , Harley Pandolfi
  • , Andre Pupo
  • , Flavio Metidieri Ramos
  • , Almino Cardoso Ramos
  • , Leonardo Teixeira Rodrigues
  • , Guilherme Becker Sander
  • , Rodrigo Dallegrave Correa da Silva
  • , Jose Americo Gomides de Sousa
  • , Mauricio Spagnol
  • , Eduardo Nobuyki Usuy
  • , Julio Cesar de Soares Veloso
  • , Hans Roman Wulf Vieira
  •  & Jorge Luiz de Mattos Zeve

Corresponding author

Correspondence to André F. Teixeira.

Ethics declarations

Conflict of Interest

Drs. Manoel Galvão Neto, Luiz Gustavo de Quadros, Thiago Ferreira de Souza, Eduardo Grecco, Admar Concon Filho, and Felipe Matz are consultants for Apollo Endosurgery. Dr. Andre Teixeira is a consultant for Intuitive Surgical.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Does not apply.

Additional information

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Appendix

Appendix

Brazilian Endoscopic Sleeve Gastroplasty Collaborative:

Adriano Tomas Vasconcelos Alexandre, Digestive Center, Fortaleza, Brazil.

Leonardo Salles de Almeida, Instituto Mineiro de Obesidade, Belo Horizonte, Brazil.

Jose Rubes Arnoni, Clinica Imec, Sao Paulo, Brazil.

Fermanda Nascimento Bueno, Endovale Clinica, Sao Jose dos Campos, Brazil.

Keila Regina Matos Cantanhebe, Hospital Sao Domingos, Sao Luis, Brazil.

Rafael Pasqualini de Carvalho, Medicina de Ribeirao Preto-USP, Ribeiro Preto, Brazil.

Alexandre Cenatti, Unimed Hospital, Casias do Sul, Brazil.

Bruna Durelli, Clinica Scoppo, Sao Paulo, Brazil.

Elaine Moreira Ferreira, Endovitta Institute, Santo Andre, Brazil.

Luiz Henrique de Sousa Filho, Clinica Cirurgica Digestiva e Obesidade, Goiania, Brazil.

Idiberto Jose Zotarelli Filho, Kaiser Clinic, Sao Jose do Rio Preto, Brazil.

Anna Carolina Hoff, Angioskope Vale, Sao Jose dos Campos, Brazil.

Mauro Rodrigues Coelho Jacome, Clinica Cronos Endoscopia, Belo Horizonte, Brazil.

Muhammad Jawad, Orlando Regional Medical Center, Orlando, FL, USA.

Igor Marchetti, Servico de Endoscopia Diagnostica e Terepeutica, Sorocaba, Brazil.

Luis Augusto Matta, Clinica Lev, Uberlandia, Brazil.

Tulio Medeiros, Clinica Scoppo, Sao Paulo, Brazil.

Luiz Henrique Mazzonetto Mestieri, Clinica Mestieri, Salto, Brazil.

Marcius Vinicius de Moraes, Instituto Endogastro, Goiania, Brazil.

Joao de Siqueira Neto, Universidade Federal do Espirito Santo, Vitoria, Brazil.

Alvaro Oliveira Neto, Nucleo Integrado de Obesidade e Diabetes, Itabuna, Brazil.

Joffre Rezende Neto, Instituto de Gastroenterologia de Goiania, Goiania, Brazil.

Harley Pandolfi, Gastroclinica de Palmas, Palmas, Brazil.

Andre Pupo, Ipiranga Hospital, Mogi das Cruzes, Brazil.

Flavio Metidieri Ramos, Endodiagnostic Clinic, Rio de Janeiro, Brazil.

Almino Cardoso Ramos, Gastro-Obeso-Center, Sao Paulo, Brazil.

Leonardo Teixeira Rodrigues, Compexo Hospitalar de Niteroi, Niteroi, Brazil.

Guilherme Becker Sander, Ernesto Dornelles Hospital, Porto Alegre, Brazil.

Rodrigo Dallegrave Correa da Silva, Clinobeso, Porto Alegre, Brazil.

Jose Americo Gomides de Sousa, Clinica Lev, Uberlandia, Brazil.

Mauricio Spagnol, Clinica Cirurgica Chapeco, Chapeco, Brazil.

Eduardo Nobuyki Usuy, Clinica Gastrica, Florianopolis, Brazil.

Julio Cesar de Soares Veloso, Instituto do Aparelho Digestivo, Brasilia, Brazil.

Hans Roman Wulf Vieira, Hansgastroclinica, Blumenau, Brazil.

Jorge Luiz de Mattos Zeve, Gastrocentro de Palmas, Palmas, Brazil.

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Neto, M.G., Silva, L.B., de Quadros, L.G. et al. Brazilian Consensus on Endoscopic Sleeve Gastroplasty. OBES SURG 31, 70–78 (2021). https://doi.org/10.1007/s11695-020-04915-4

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  • DOI: https://doi.org/10.1007/s11695-020-04915-4

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