Combined Endoscopic Sleeve Gastroplasty (ESG) and Primary Obesity Surgery Endoluminal (POSE) as a Primary Procedure for Weight Loss: 2017 Presidential Poster Award

Abstract

Introduction: Endoscopic bariatric techniques have emerged as effective therapies in nonsurgical management of obesity. Primary Obesity Surgical Endoluminal (POSE) is an endoscopic technique that involves placement of a gastric transmural plications in the fundus and pre-antral area to trigger earlier physiologic feedback of fullness and less hunger. Endoscopic Sleeve Gastroplasty (ESG) consists in reduction of the gastric functional volume, in length and width, creating a narrow luminal sleeve. ESG is reversible, incisionless and minimally invasive procedure, performed via endoscopic placement of full-thickness sutures. The objective of this study is to critically evaluate the safety and efficacy of the combined procedure POSE and ESG on body weight loss. Methods: We are presenting our initial experience on the safety and early weight loss with the combined procedure POSE and ESG, conducting a prospective single-center study. To our knowledge this the fisrt human study looking at such technique.Currently, 5 patients (2 men, 3women) underwent the combination of POSE and ESG. One patient lost follow up.The procedures were performed using the Incisionless Operating PlatformTM (IOP) (USGI Medical) for POSE and the Apollo OverstitchTM device (Apollo Endosurgery, Inc.), a cap-based flexible endoscopic suturing system for ESG.Figure: BMI through 4 Months.Figure: %TBWL through 4 Months.Results: A maximum 4 months follow up was achieved on 3 patients. Initial mean body mass index (BMI) was 36.4 ± 2.5 Kg/m2(range 33.6 - 39.1) and mean age was 39.8 ± 4.6 years (range 34 - 45).Absolute change in mean BMI was 2.6 and 5.7 Kg/m2 at 1 and 4 months, respectively. Mean %TBWL was 7.1 ± 0.8% and 16.7 ± 2.0% at 1 and 4 months, respectively. There were no major intra procedural or early adverse events. Oral contrast studies at 24 hours were done and showed no leaking contrast. Mean discharge time after the procedure was 24 hours. Conclusion: The preliminary data of this study showed that combined procedure POSE and ESG procedure appears to be an effective and safe tool for weight reduction without significant adverse events. Initial results in weight loss are encouraging although long term follow up with larger sample size is required.