The Skinny on Endoscopic Sleeve Gastroplasty: A Single Center Experience for the Treatment of Obesity in 91 Patients

Abstract

Introduction: Endoscopic sleeve gastroplasty (ESG) is a novel, incisionless, minimally invasive bariatric treatment performed via an endoscopic approach for the management of obesity. Comparable to a surgical sleeve gastrectomy, the goal of an ESG is to reduce the length and width of the gastric cavity to facilitate weight loss. The aim of this study was to evaluate if ESG can result in successful improvement in total body weight loss (TBWL) at 12 months. In addition, we aim to show improvement in patient comorbidities after successful weight loss secondary to ESG. Methods: Ninety-one consecutive patients undergoing ESG between August 2013 and March 2016 were included in this single center, prospective study. All procedures were preformed by using a cap-based flexible endoscopic suturing system (OverStitch; Apollo Endosurgery) to perform an interrupted triangular pattern of sutures to invaginate the greater curvature of the stomach for formation of the sleeve. The primary outcome was total body weight loss (TBWL) at 6, 12 and 18 months. Secondary outcomes included the impact of ESG on metabolic comorbidities. Univariate analysis was conducted using chisquared and t-test, while multivariable regression was conducted to predict successful weight loss with STATA 13.0. Results: Ninety-one consecutive patients undergoing ESG between August 2013 and March 2016 were included in this single center, prospective study. The mean age was 43.66 ± 11.26 years (range 19 - 66), mean BMI 38.6 ± 7.0 kg/m2 (range 30-68.0), 68% were female, and 34% caucasian. On follow up, 52 patients reached 6-months, 28 patients reached 12 months and 12 patients had 18 month follow up. At six months, the mean percent TBWL was 14.4%, increased to 17.6% at 12 months, and 19.1% at 18 months (Figure 1). For patients before and after ESG, there was a statistically significant improvement in HgA1c in pre-diabetics (p=0.014), systolic blood pressure (p=0.023), waist circumference (p < 0.001), ALT (p < 0.001), and serum triglycerides (p=0.017) (Table 1). However there was no significant improvement in LDL (p=0.786) or serum leptin (p=0.476).Figure 1Table 1: Post-ESG Improvement in Medical Co morbidities at 12 monthsConclusion: This study demonstrates that ESG is a minimally invasive and effective endoscopic weight loss intervention. In addition to sustained total body weight loss after 24 months, ESG is also associated with improved medical comorbidities such as hypertension, diabetes and hyperlipidemia.