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Performance Characteristics of Endoscopic Sleeve Gastroplasty in Patients with Prior Intragastric Balloon: Results of a Propensity Score Matched Study

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Abstract

Introduction

The performance characteristics of endoscopic sleeve gastroplasty (ESG) for weight recurrence after intragastric balloon (IGB) are unknown.

Methods

This is a retrospective propensity score matched study of ESG after IGB (IGB-to-ESG) vs ESG without prior IGB (ESG-only). The primary outcome was total weight loss (TWL) at 12 months. Secondary outcomes included TWL at 3 and 6 months, 12-month excess weight loss (EWL), procedural characteristics, and safety.

Results

Thirty-nine adults underwent ESG from August 2020 to September 2022 after IGB explantation a median of 24 months (range 2–56 months) prior and a median post-IGB nadir weight increase of 100.0% (range 0 to 3200%). An ESG-only 2:1 age- sex- and BMI- propensity score matched cohort was derived from 649 patients (Pearson’s goodness-of-fit: 0.86). TWL for IGB-to-ESG vs. ESG-only was 12.3 ± 13.5% vs. 12.4 ± 3.7% at 3 months (p = 0.97), 10.1 ± 7.1% vs. 15.4 ± 4.6% at 6 months (p < 0.001), and 8.7 ± 7.7% vs. 17.1 ± 5.7% at 12 months (p < 0.001). Twelve-month EWL for IGB-to-ESG vs ESG-only was 27.8 ± 46.9% vs 62.0 ± 21.0% (p < 0.001). There was no difference in mean procedural duration of ESG; however, more sutures were used with IGB-to-ESG vs. ESG-only (7 vs. 6, p < 0.0002). There were no serious adverse events in either cohort.

Conclusion

ESG after IGB produces safe, acceptable weight loss but with an attenuated effect compared to ESG alone. Further study is required to understand the factors driving this discrepancy.

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Data Availability

Upon request, relevant data and documentation to verify results can be provided. 

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Authors and Affiliations

  1. True You Weight Loss, 5673 Peachtree Dunwoody Road, Ste 470, Atlanta, GA, 30342, USA

    Daniel B. Maselli & Lauren L. Donnangelo

  2. True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA

    Areebah Waseem, Daniel Lee, Chase Wooley, Brian Coan & Christopher E. McGowan

Authors
  1. Daniel B. Maselli
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  2. Areebah Waseem
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  3. Daniel Lee
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  4. Chase Wooley
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  5. Lauren L. Donnangelo
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  6. Brian Coan
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  7. Christopher E. McGowan
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Contributions

DBM—protocol preparation, manuscript preparation; AW—protocol preparation, manuscript revision; DL—data collection, manuscript revision; CW—protocol preparation, manuscript revision; LLD—manuscript revision; BC—manuscript revision; CEM—study conceptualization, protocol preparation, manuscript revision.

Corresponding author

Correspondence to Christopher E. McGowan.

Ethics declarations

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to Participate

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

Conflict of Interest

Author 1 and Author 7 are or have been consultants for and have received honorarium from Apollo Endosurgery, the organization that makes the Orbera intragastric balloon and the Overstitch endoscopic suturing system used to create the endoscopic sleeve gastroplasty.

IRB

The study was approved by an Institutional Review Board (WCG IRB, Puyallup, WA).

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None.

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Key Points

• Patients may seek endoscopic sleeve gastroplasty (ESG) for weight recurrence after intragastric balloon (IGB) therapy, but the performance characteristics of ESG after IGB are unknown.

• ESG after IGB was technically feasible and safe; however, compared with patients who underwent ESG without prior IGB therapy, those who underwent ESG after IGB treatment had attenuated weight loss at 6 and 12 months. In addition, the clinical response at 12 months from ESG was suboptimal in the majority who had prior IGB therapy based on total weight loss parameters.

• In patients with prior IGB therapy, a higher body mass index at the time of ESG predicted greater weight loss from ESG.

• While ESG produced safe weight loss after IGB, patients should be counseled on the potential for diminished weight loss effects from ESG when used after IGB therapy.

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Maselli, D.B., Waseem, A., Lee, D. et al. Performance Characteristics of Endoscopic Sleeve Gastroplasty in Patients with Prior Intragastric Balloon: Results of a Propensity Score Matched Study. OBES SURG 33, 2711–2717 (2023). https://doi.org/10.1007/s11695-023-06715-y

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