Percent Total Body Weight Loss Research Articles

Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss

Endoscopic sleeve gastroplasty (ESG) has been shown to be effective for inducing weight loss. The efficacy of liraglutide, a glucagon-like peptide-1 agonist, to augment weight loss after ESG is unknown. This study aims to evaluate the efficacy of ESG and liraglutide (ESG-L) compared with ESG alone. This was a retrospective study of prospectively collected data from patients undergoing ESG at 3 outpatient clinics in Brazil between November 2017 and July 2018. Liraglutide was offered to all patients 5 months after ESG. Patients who opted to take liraglutide (ESG-L) were matched 1:1 to patients who declined it (ESG). The primary outcome was percent total body weight loss (%TBWL), and percent excess weight loss (%EWL) 7 months after initiation of liraglutide (12 months after ESG). The secondary outcome was change in percent body fat 12 months after ESG. ESG technique and postprocedure follow-up were identical at all 3 sites. Propensity score matching yielded 26 matched pairs. Adjusted comparisons between the 2 groups showed that patients who opted to take liraglutide had a superior mean %TBWL 7 months after initiation of liraglutide (ESG-L) compared with those who declined it (ESG) (24.72% ± 2.12% vs 20.51% ± 1.68%, respectively; P< .001). ESG-L had a statistically greater reduction in percent body fat compared with ESG (7.85% ± 1.26% vs 10.54% ± 1.88%, respectively; P< .001) at 12 months. Addition of liraglutide at 5 months results in superior weight loss and improved efficacy as demonstrated by decreased body fat 12 months after ESG. Further studies are imperative to determine optimal dose, timing, and duration of liraglutide.

S1202 The Origin of Obesity Does Not Affect Short Term Weight Loss After Vertical Sleeve Gastrectomy

INTRODUCTION: sychosocial factors (i.e. diet/physical activity/stress), genetic risk, and obesogens (early life endocrine disruptors) have each been suggested to be major underlying mechanisms involved in the obesity pandemic. Vertical sleeve gastrectomy (VSG) has emerged as the preferred weight loss surgery worldwide; VSG has an improved safety profile and good long term outcomes. Since genetic risk and obesogens are pathophysiological factors independent of an individual’s control, our hypothesis is that VSG will result in better weight loss in subjects whose obesity is related to psychosocial factors, compared to subjects with genetic risk or exposure to obesogens. METHODS: This is a retrospective review of 84 new obese subjects, who live in urban and suburban locations, who were seen in a community teaching hospital bariatric GI clinic from Oct 2018 to June 2019 and underwent VSG with at least 6 months of follow up. Obesogen (O) exposure is defined by: mother and father normal weights; subject had body mass index (BMI) of ≥ 30 kg/m2 at age 18. Genetic risk (GR) is defined by: mother and/or father obese; subject had BMI of ≥ 30 at age 18. Psychosocial (PS) factors are defined by: subject with BMI < 30 at age 18. RESULTS: As shown in Table1/Table2, subjects with genetic risk are significantly younger, while subjects with exposure to obesogens or with genetic risk have higher weights and higher BMIs at presentation. Percent total body weight loss at 6 months was not different among the three groups, but few men were seen for 6 months of follow up. Higher BMI individuals did not demonstrate a reduction in mean weight loss. CONCLUSION: This study did not support improved short term weight loss after VSG in individuals with obesity related to psychosocial factors. Potential difference in results among the three groups will need to be examined in long term studies, in which additional men are available for analysis. Further prospective studies are needed to evaluate the potential clinical significance of subjects exposed to obesogens.Table 1.: DemographicsTable 2.: Statistical analysis

Building an endobariatric program: lessons learned.

The emphasis on treating obesity has never been more critical, yet the complexity of delivering care has become more intricate due to new procedures, variable insurance coverage, and inconsistent reimbursement. This is our experience building an endobariatric program and treating overweight and obese patients with endobariatric therapies (EBTs) over 3 years. The primary intention of this manuscript was to educate the reader on how to build an endobariatric program, identify barriers, and provide succinct solutions to establish a successful program. The secondary aim was weight loss outcomes of procedures offered at our institution. We compiled a list of lessons learned, based on the difficulties we experienced to make it easy for others embarking on this journey. Herein, we present a business development strategy to overcome impediments, whilst offering high quality service. The high cost and lack of insurance coverage are significant barriers. Marketing can be costly and is often a factor that is ignored particularly early on, when finances are limited. However, it is an integral component of growing the program. The percentage total body weight loss (%TBWL) at 6 and 12 months post ESG was 17.8 ± 6.48 and 20.6 ± 8.3 ( P < 0.001), respectively. The %TBWL at 6 months post IGB was 14.9 ± 9.8 for the Orbera IGB and 12.6 ± 7.4 for the Reshape IGB. There was a trend of preference for ESG compared to IGB placement over the 3 years. The key to building a successful endobariatric program is a motivated physician leader, collaborative bariatric surgeons, institutional support, and marketing. Insurance coverage will likely occur in the near future and programs must be prepared to manage the massive influx of patients that will likely request these procedures.

Brazilian Consensus on Endoscopic Sleeve Gastroplasty.

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. 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. The panel's experience consisted of 1828 procedures, with a mean percentage total body weight loss (TBWL) of 18.2% in 1year. 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. 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.

Sa1947 DOES FUNDAL SUTURING AFFECT OUTCOMES OF ENDOSCOPIC SLEEVE GASTROPLASTY?

The endoscopic sleeve gastroplasty (ESG) is a neoteric minimally invasive bariatric procedure that has gained recent acclaim in the management of obesity. However, there is heterogeneity regarding technical aspects such as plication of the gastric fundus. Fundal suturing (FS) is avoided due to the belief that suturing the anatomically thin fundus would significantly increase the risk of complications, however, there is a paucity of literature pertaining to fundal suturing. We sought to determine whether suturing the gastric fundus affects weight loss outcomes and adverse event rate when compared to ESG without fundal suturing. We conducted a two-center retrospective analysis of prospectively maintained data of 247 patients who underwent ESG with or without fundal suturing between January 2016 and August 2019. Endoscopist A had trained endoscopist B to perform ESG. Endoscopist A conducted ESG with suturing of the fundus at center A (group A), while endoscopist B conducted ESG without fundal sutures at center B (group B). The primary outcome was the mean absolute weight loss (AWL), percent excess weight loss (%EWL) and percent total body weight loss (%TBWL) at 3, 6 and 12 months post ESG. Secondary outcomes included severe adverse event (SAE) rate and procedure duration. Uni-variable and multivariable analyses were used to compare outcomes of ESG with and without fundal suturing. Baseline demographic characteristics were similar, except for a significantly greater proportion of females in group B (85.7% vs 71.8 %) (p=0.017). A total of 178, 131, and 66 patients completed follow up at 3, 6 and 12 months respectively. At 3 months group A had a significantly greater mean %TBWL, 13.81 ± 4.55 % compared to 11.71 ± 3.60 % in group B (p = 0.001), and a higher %EWL(44.17± 21.24% vs. 37.72 ± 16.10% )(p=0.025). This remained significant on multiple regression analysis after controlling for other covariates. However, this difference did not remain significant at 6 and 12 month. The SAE rate was comparable in group A (n=4;2.6%) and group B (n=2; 2.0%) (p=1) (Table 1). The mean procedure time was significantly longer in the group A, 92.96 ± 35.5 vs. 59.13 ± 32.7 minutes (p<0.001) , in the setting of a greater mean number of sutures 8.41 ± 1.58 vs 5.72 ± 1.10 (p<0.001). This is the first study to date comparing outcomes of ESG with fundal suturing versus ESG without fundal suturing. Although, fundal suturing adds procedure time, it does not increase the adverse event rate, while achieving significantly greater %TBWL and %EWL at 3 months. There is a need for a larger multicenter comparative study that may demonstrate that early %EWL could translate to superior weight loss outcomes in the long term.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The effect of weight loss and exercise on Health-Related Quality of Life (HRQOL) following Endoscopic Bariatric Therapies (EBT) for obesity

IntroductionEndoscopic bariatric therapies (EBT) have demonstrated to induce weight loss and improve comorbidities in obese patients. However, little is known about its impact on health-related quality of life (HRQOL) outcomes and physical activity status. This study aimed to evaluate the change in HRQOL and physical activity following EBT induced weight loss in obese patients.MethodsWe approached 181 patients who underwent EBT in a standardized multidisciplinary follow-up program to participate in the study. We provided them two questionnaires-a) Short Form-36 health survey with the physical (PSC) and mental (MSC) summary component scores to capture generic HRQOL, and b) international physical activity questionnaire (IPAQ) for physical activity (PA). We administered the survey at baseline and at 9 months post-procedure. We expressed the procedure outcome as percentage total body weight loss (%TBWL). We expressed continuous variables as mean (SD) or median and categorical variables as percentages. We used non-parametric tests for comparison and performed multivariable linear regression analysis to identify factors associated with improvement in HRQOL.ResultsThe mean age was 42.2 (11.3) years, and the mean BMI was 38 (5.9)kg/m2. A majority of them were female (n-132, 73%). The EBT included intragastric balloons (n-136, 75%) and endoscopic sleeve gastroplasty (n-24, 25%). The mean %TBWL achieved after the intervention was 16.9 (9.7)%. We noticed a significant improvement in the median PSC (77.8 vs. 90.4, p < 0.001) and MSC (67 vs. 80.2, p < 0.001) scores after EBT. Similarly, we observed a significant positive change in physical activity compared to baseline (1606.2 vs. 2749 MET-minutes/week, p = < 0.001). Linear regression analysis showed an increase in %TBWL was associated with significant improvement in PSC (β = 0.193, p = 0.003) and MSC (β = 0.166, p = 0.02) scores of HRQOL, and likewise, increase in PA was independently associated with improvement in MSC (β = 0.192, p = 0.01). We did not find any difference in outcome based on gender or the type of intervention.ConclusionEBT improves HRQOL in obese patients regardless of the type of intervention. The weight loss induced by EBT and the improvement in PA positively influence the health outcomes and quality of life.

Intragastric Balloon Placement Induces Significant Metabolic and Histologic Improvement in Patients With Nonalcoholic Steatohepatitis

Obese patients with nonalcoholic steatohepatitis (NASH) are at risk for cirrhosis if significant weight loss is not achieved. The single fluid-filled intragastric balloon (IGB) induces meaningful weight loss and might be used in NASH treatment. We performed an open-label prospective study to evaluate the effects of IGB placement on metabolic and histologic features of NASH. Twenty-one patients with early hepatic fibrosis (81% female; mean age, 54 years; average body mass index, 44 kg/m2) underwent magnetic resonance elastography (MRE) and endoscopic ultrasound with core liver biopsy collection at time IGB placement and removal at a single center from October 2016 through March 2018. The primary outcome measure was the changes in liver histology parameters after IGB, including change in nonalcoholic fatty liver disease activity score (NAS) and fibrosis score. We also evaluated changes in weight, body mass index, waist to hip ratio, aminotransaminases, fasting levels of lipids, fasting glucose, glycosylated hemoglobin, and MRE-detected liver stiffness. Six months after IGB, patients' mean total body weight loss was 11.7% ± 7.7%, with significant reductions in HbA1c (1.3% ± 0.5%) (P = .02). Waist circumference decreased by 14.4 ± 2.2 cm (P = .001). NAS improved in 18 of 20 patients (90%), with a median decrease of 3 points (range, 1-4 points); 16 of 20 patients (80%) had improvements of 2 points or more. Fibrosis improved by 1.17 stages in 15% of patients, and MRE-detected fibrosis improved by 1.5 stages in 10 of 20 patients (50%). Half of patients reached endpoints approved by the Food and Drug Administration of for NASH resolution and fibrosis improvement. Percent total body weight loss did not correlate with reductions in NAS or fibrosis. Other than post-procedural pain (in 5% of patients), no serious adverse events were reported. In a prospective study, IGB facilitated significant metabolic and histologic improvements in NASH. IGB appears to be safe and effective for NASH management when combined with a prescribed diet and exercise program. ClinicalTrials.gov no: NCT02880189.

Personalization of Endoscopic Bariatric and Metabolic Therapies Based on Physiology: a Prospective Feasibility Study with a Single Fluid-Filled Intragastric Balloon.

The intragastric balloon (IGB) is commonly used for weight loss. Identifying patients who are most likely to tolerate and benefit from IGB therapy will optimize outcomes. Our aims were to prospectively utilize a gastric emptying study to predict intolerance and treatment response with a single fluid-filled IGB and to develop a physiologic prediction model with a treatment algorithm. A total of 32 patients had a gastric emptying study before and 2-3months after placement of an IGB. Multiple logistic regression analyses were performed to calculate likelihood ratios and to develop a physiologic prediction model. Patients in the higher gastric retention quartile at baseline had a 6.2-time higher likelihood ratio for early balloon removal secondary to intolerance (p= 0.013). Utilizing baseline gastric emptying to predict intolerance to the IGB may have prevented 75% of early removal cases. Decreased gastric emptying at 3months after balloon placement was significantly correlated with percent total body weight loss (%TWBL) at 6 and 12months (p= 0.01 and p= 0.014, respectively). At 6months after IGB, patients with no change in their gastric emptying at 3months lost significantly less weight compared with those with increased gastric retention (median %TBWL = 9.0% [4.5-14.7] versus 17.3% [12.2-24.4], p= 0.016). Utilizing gastric emptying as a physiologic predictor of intolerance and response to the single fluid-filled IGB can improve outcomes. This pilot feasibility trial ushers in the era of personalized endoscopic bariatric therapies to maximize patients' tolerance, cost-effectiveness, and meaningful weight loss.

Negative Affect and Loss of Control Eating Among Bariatric Surgery Patients: an Ecological Momentary Assessment Pilot Investigation.

Research shows that loss of control (LOC) eating impacts weight outcomes following bariatric surgery, but mechanisms explaining the development and/or maintenance of post-surgical LOC eating remain unclear. Ecological momentary assessment (EMA) research among eating disorder populations has demonstrated prospective relationships between negative affect (NA) and LOC eating; however, this momentary effect has not been examined among bariatric surgery patients. Thus, this study used EMA data to examine momentary relationships between NA and LOC eating among pre- and post-bariatric surgery patients. Fourteen pre- and 17 post-RYGB patients completed 2weeks of EMA data collection. Participants responded to seven signals daily wherein they rated their mood and severity of LOC eating. Higher momentary NA predicted more severe LOC eating for all participants. Group had a moderating effect, demonstrating that the association between NA and LOC eating was stronger among the post-surgery group. Percent total body weight loss (%TBWL) had a moderating effect within the post-surgery group, demonstrating that the relationship between NA and LOC eating was stronger for those who experienced less weight loss. Finally, between-subjects analyses revealed that, for individuals with lower %TBWL, lower overall NA and higher overall positive affect (PA) were related to greater LOC eating. This research demonstrates that affect influences the effect of LOC eating on weight loss following bariatric surgery. While further work is needed to extend these preliminary findings, this research suggests that affective experience might become an important target in the assessment and treatment of LOC eating among bariatric patients.

Laparoscopic Roux en Y gastric bypass in the super obese.

Bariatric surgery in super obese patients presents technical, metabolic and risk related challenges. Moreover, there is concern that weight loss and health outcomes of surgery, including gastric bypass, may be lesser than in non super obese (morbidly obese) patients. This may drive clinicians toward more aggressive forms of surgery at the risk of greater morbidity. This review examines outcomes pertaining to laparoscopic Roux en Y gastric bypass (LRYGB) in the super obese and determines the role of such surgery in the current day. Whilst a minor increase in morbidity and mortality risk exists, weight loss outcomes when measured as percentage total body weight loss are equivalent to non super obese patients. Final BMI is not an appropriate indicator of benefit in such patients and may lead to escalation surgery inappropriately. Surgeons employing the use of LRYGB in the super obese should have adequate training and expertise in the technique and operating upon super obese patients should be avoided during the learning curve phase to minimise morbidity risk.

Endoscopic management of dumping syndrome after Roux-en-Y gastric bypass: a large international series and proposed management strategy

Roux-en-Y gastric bypass (RYGB) is refractory to lifestyle and pharmacotherapy measures, requiring reversal of the patient's bariatric surgery. Reversal can lead to weight regain and recrudescence of their comorbidities. Our aim was to report a multicenter experience on the endoscopic management of refractory dumping syndrome with endoscopic transoral outlet reduction (TORe). A multicenter international series of consecutive patients who underwent TORe with a full-thickness endoscopic suturing device was analyzed for technical success, improvement in Sigstad scores, and weight trajectories after the procedure. Failure was defined as needing an enteral feeding tube, surgical reversal, or repeat TORe. One hundred fifteen patients across 2 large academic centers in Germany and the United States underwent TORe for dumping syndrome. Patient age was mean 8.9 ± 1.1 years from their initial RYGB with an average percent total body weight loss of 31% ± 10.6% at the time of endoscopy. Three months postprocedure, the Sigstad score improved from a mean of 17 ± 6.1 to 2.6 ± 1.9 (paired t test P= .0001) with only 2% of patients (n= 2) experiencing weight gain. Mean weight loss and percentage of total body weight loss 3 months post-TORe were 9.47 ± 3.6 kg and 9.47% ± 2.5%, respectively. Six patients (5%) failed initial endoscopic therapy, with 50% (n= 3) successfully treated with a repeat TORe. Three patients underwent surgical reversal, indicating an overall 97% endoscopic success rate. TORe as an adjunct to lifestyle and pharmacologic therapy for refractory dumping syndrome is safe and effective at improving dumping syndrome and reducing rates of surgical revision.

Early outcome of bariatric surgery for the treatment of type 2 diabetes mellitus in super-obese Malaysian population.

Introduction:Despite many challenges, the benefit of bariatric surgery in super-obese population remains irrefutable with significant improvement in metabolic syndrome and quality of life. There are currently no published data from Malaysia on this topic.Objective and Methodology:A single-centre retrospective study aimed at analysing the outcome of laparoscopic bariatric surgery on super-obese Malaysians with type 2 diabetes mellitus (T2DM) at 12 months following surgery. Demographic details, glycaemic control and weight-loss parameters were analysed. P < 0.01 was considered statistically significant.Results:Of the 33 patients, 55% were women and 45% were men with a mean age of 40 ± 11 years and body mass index (BMI) of 59.3 ± 9.0 kg/m2. Majority of patients were of Malay ethnicity (82%). Malaysian-Indians and Malaysian-Chinese each accounted for 9% of total case volume. The three types of laparoscopic bariatric surgery recorded in this study were sleeve gastrectomy (82%), Roux-en-Y gastric bypass (9%) and mini-gastric bypass (9%) with operative time of 103.5 ± 31.1, 135.8 ± 32.6 and 116.2 ± 32.3 min, respectively. Percentage total body weight loss was 33.11% ± 9.44% at 12 months following surgery (P < 0.01). BMI change and percentage excess BMI loss showed similar improvement. Glycosylated haemoglobin and fasting blood sugar decreased from pre-operative values of 7.0% ± 1.0% and 7.0 ± 0.9 mmol/L to 5.6% ± 0.4% and 5.0 ± 0.6 mmol/L at 12 months (P < 0.01). Remission of T2DM was noted in 93% of patients. There was no correlation between weight loss and improvement in glycaemic status.Conclusion:There are significant weight loss and improvement of glycaemic control at 12 months post-laparoscopic bariatric surgery among super-obese Malaysians.

Bariatric endoscopy procedure type or follow-up: What predicted success at 1 year in 962 obese patients?

Background and study aims It is uncertain if the difference in weight loss outcomes between different endoscopic bariatric therapies (EBTs) is technique-related or multidisciplinary team (MDT) follow-up-related. We hypothesized that at 1 year, the weight loss is determined more by adherence to MDT follow-up than by procedure type. We aimed to compare 1 year weight loss outcomes of four different EBTs at a single center with a standardized MDT follow-up. Patients and methods We prospectively collected and retrospectively analyzed outcomes in 962 patients (female-691, 71.2 %; mean age, 44.8 ± 10.6 years, mean BMI, 37.8 ± 5.9 Kg/m 2 ) treated with Intragastric balloons (IGBs) or endoscopic gastroplasty (EG) at HM Sanchinarro University Hospital between March 2012 to January 2017. The procedures were performed by the same endoscopist and followed up by the same MDT. We compared the percentage total body weight loss (%TWBL) at 1 year. We performed linear and logistic regression to identify predictive factors for weight loss and follow-up adherence at 1 year. Results Four hundred and eighty-one IGBs (Orbera-80.9 %; ReShape Duo-19.1 %), and 481 EG (Apollo ESG-51.3 %; Primary obesity surgery endoluminal-POSE-48.6 %) were performed. Only 480 patients (IGB- 45 %; EG- 55 %) completed 1 year follow-up. Among them, Apollo ESG achieved significantly higher TBWL (19.5 ± 13 %, P = 0.035), %TBWL (17.4 ± 10.2 %, P = 0.025), and ≥ 20 % TBWL (36.7 %, P = 0.032). However, in linear regression after adjusting for variables, only higher initial BMI (B = 0.31, P < 0.001) and higher percentage follow-up attendance (B = 0.24, P < 0.001) significantly predicted %TBWL at 1 year in the completion group but not the procedure type (B = 0.02, P = 0.72). In logistic regression, we observed female sex ( P = 0.01), high initial BMI ( P < 0.001), endoscopic gastroplasty ( P = 0.04), and high 1-month %TBWL ( P < 0.001) significantly predicted follow-up completion at 1 year. Conclusions Weight loss at 1 year is dependent on MDT follow-up rather than procedure type. Endoscopic gastroplasty promoted follow-up adherence more than IGBs.

Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery

Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c <6.5%. Relapse was defined as recurrence medication use and/or hemoglobin A1c ≥6.5%. Independent correlates of T2D remission and relapse were identified using logistic regression. Six hundred and twenty-one patients (aged 46.7 ± 10.6 years; 30% on insulin; BMI 49.8 ± 8.3 kg/m2) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse. This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission.

Genetic Obesity and Bariatric Surgery Outcome in 1014 Patients with Morbid Obesity.

Mutations in the leptin-melanocortin pathway genes are known to cause monogenic obesity. The prevalence of these gene mutations and their effect on weight loss response after bariatric surgery are still largely unknown. To determine the prevalence of genetic obesity in a large bariatric cohort and evaluate their response to bariatric surgery. Mutation analysis of 52 obesity-associated genes. Patient inclusion criteria were a BMI > 50kg/m2, an indication for revisional surgery or an early onset of obesity (< 10years of age). A total of 1014 patients were included, of whom 30 (3%) were diagnosed with genetic obesity, caused by pathogenic heterozygous mutations in either MC4R, POMC, PCSK1, SIM1, or PTEN. The percentage total body weight loss (%TBWL) after Roux-en-Y gastric bypass (RYGB) surgery was not significantly different for patients with a mutation in MC4R, POMC, and PCSK1 compared with patients lacking a molecular diagnosis. Of the confirmed genetic obesity cases, only patients with MC4R mutations receiving a sleeve gastrectomy (SG) showed significantly lower %TBWL compared with patients lacking a molecular diagnosis, during 2years of follow-up. In this cohort of morbid obese bariatric patients, an estimated prevalence of monogenic obesity of 3% is reported. Among these patients, the clinical effects of heterozygous mutations in POMC and PCSK1 do not interfere with the effectiveness of most commonly performed bariatric procedures within the first 2years of follow-up. Patients with MC4R mutations achieved superior weight loss after primary RYGB compared with SG.

A262 Negative Affect and Loss of Control Eating among Bariatric Surgery Patients: A Preliminary Ecological Momentary Assessment Investigation

Evidence suggests that loss of control (LOC) eating impacts weight loss outcomes following bariatric surgery; however, mechanisms explaining the development and/or maintenance of LOC remain unclear. Research utilizing ecological momentary assessment (EMA) has demonstrated prospective relationships between negative affect (NA) and LOC within the eating disorder literature, but this effect has not been examined within a bariatric surgery population using momentary data. This study explored whether higher NA led to greater LOC among bariatric surgery patients and if the relationship differed before versus after surgery. Fourteen pre- and 17 post-RYGB patients completed two weeks of EMA signaling. Participants responded to seven signals each day and rated their current mood and experience of LOC since the last signal. Results from a Generalized Linear (GEE) model demonstrated that higher NA predicted higher ratings of LOC at the next signal (B = .223, χ2(1) = 58.87, p < .001) and that group had a moderating effect (B = -.163, χ2(1) = 15.19, p < .001), wherein the post-surgery had a stronger association between NA and LOC relative to the pre-surgery group. Post-hoc analyses among the post-surgery group demonstrated that body mass index (BMI) change, percent excess BMI loss, and percent total body weight loss moderated the relationship between NA and LOC (p’s < .05), such that the relationship between NA and LOC was stronger for those who had experienced less weight loss. These preliminary findings implicate NA as a possible target for improving weight loss outcomes. Limitations and future directions will be discussed.

1140 Endoscopic Sleeve Gastroplasty versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis

INTRODUCTION: Bariatric surgery remains the most effective and durable treatment for obesity; yet, less than 2% of eligible candidates undergo surgery. Endoscopic sleeve gastroplasty (ESG) is a restrictive procedure that simulates the anatomical changes associated with laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric procedure. We performed a meta-analysis to compare clinical outcomes between ESG and LSG. METHODS: Comprehensive search of multiple databases (PubMed, EMBASE, Cochrane, Web of Science) since the inception of ESG (2013) to April 2019. Studies were included if they reported data needed for calculation of post-intervention percentage total body weight loss (%TBWL) and adverse events. Pooling was conducted by using either fixed or random-effects model depending on heterogeneity across studies. RESULTS: A total of 5822 studies were initially identified, of which 18 studies (1446 ESG and 2071 LSG patients) were included. The pooled mean %TBWL at 6 months was lower in the ESG group (14.3; 95% CI: 12.8-15.9) when compared to LSG (25.5; 95% CI:23.9-27.2) (P &lt; 0.001). Similarly, the estimated mean %TBWL at 12 months was lower for ESG (15.7; 95% CI:13.5-17.9) versus LSG (29.5; 95% CI:27.3-31.7) (P &lt; 0.001). The pooled rate for adverse events was significantly higher in patients who underwent LSG (7.8%; 95% CI: 4.3-12.1) compared to ESG (1.9%; 95% CI: 0.7-3.7) (P &lt; 0.001). CONCLUSION: ESG achieves less weight loss at 6 and 12 months when compared to LSG, but LSG is associated with more adverse events. ESG is an acceptable minimally invasive approach for non-surgical candidates or for those seeking alternatives besides conventional bariatric surgery.

Endoscopic sleeve gastroplasty versus high-intensity diet and lifestyle therapy: a case-matched study

Endoscopic sleeve gastroplasty (ESG) is a safe and effective minimally invasive bariatric procedure. This study compared weight loss in patients undergoing ESG with that of matched patients undergoing high-intensity diet and lifestyle therapy (HIDLT). In this case-matched study, patients were matched 2/3:1 (HIDLT/ESG) by age, sex, and body mass index (BMI). One hundred five patients (30 men) who underwent ESG+ low-intensity diet and lifestyle therapy (LIDLT) between 2016 and 2018 were compared with 281 patients (92 men) who underwent HIDLT at the Johns Hopkins Medical Institutions from 2013 to 2014. Weight was evaluated 1, 3, 6, and 12months after beginning HIDLT or post-ESG to determine the mean percent total body weight loss (%TBWL). Mean age across both cohorts was 48.0 ± 12.1, and baseline BMI was 40.0 ± 7.7 kg/m2. In multivariable analysis controlling for age, sex, and baseline BMI, the mean %TBWL at 1, 3, 6, and 12 months was significantly higher in patients undergoing ESG than matched patients undergoing HIDLT. Specifically, at 3 months, the mean %TBWL in the ESG cohort was 14.0% compared with 11.3% in the HIDLT cohort (P<.011), and at 12 months the mean %TBWL in the ESG cohort was 20.6% versus 14.3% in the HIDLT cohort (P< .001). ESG patients with baseline BMI≤40 kg/m2 continued to show significantly greater %TBWL than those of the same BMI group in the HIDLT group at 1, 3, 6, and 12 months after intervention (3 months, coefficient= 3.43 [P< .001]; 12 months, coefficient= 8.14 [P< .001]). Through 12 months of follow-up, patients who underwent ESG achieved significantly greater weight loss than patients enrolled in HIDLT. ESG appears to be a valuable alternative for patients who experience difficulty complying with HIDLT.

WEIGHT LOSS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE MULTIDISCIPLINARY APPROACH OF MAGGIORE DELLA CARITA’ AOU, NOVARA

Bariatric surgery is currently considered the most effective treatment to obtain a substantial weight loss sustained on the long term in morbid obesity. We present data regarding the recent bariatric experience of candidates enrolled between July 2016 and 2018 at “Maggiore Della Carita” Novara hospital. According to international and national guidelines1-2, surgery inclusion criteria were: age 8-65 years old; BMI ≥40 kg/m2 or ≥35 kg/m2 with at least one obesity-related comorbidity; multi-disciplinary team pre-surgical evaluation of the medical and psychological conditions that could interfere with health, weight loss outcome, or follow-up compliance 3. Among 98 candidates, 40 (41%) subjects underwent a bariatric procedure; 90% (36) underwent laparoscopic sleeve gastrectomy (LSG). No serious adverse events (SAE) were observed after surgery up to 12 months. The mean baseline BMI was 44.4 kg/m2 (±5.2), with a decrease of 9.7 kg/m2 (±3.5) and 13.3 kg/m2 (±5.5) at 6 and 12 months, respectively. The Percent Excess Weight Loss (%EWL) and Percent Total Body Weight Loss (%TBWL) were 47.8 (±17.7), 61.2 (±27.6) and 21.9 (±7.5), 27.6 (±10) at 6 and 12 months, respectively. Moreover, mean serum glucose levels reduced from 110.6 (±35.5) mg/dL at baseline to 90.4 mg/dL (±14.8) and 88.3 mg/dL (±12.7) after 6 and 12 months. Detailed data are shown in the table 4. Our multidisciplinary experience in bariatric patient management demonstrates that a proper pre-surgical selection of candidates and a regular follow up are effective in obtaining a substantial weight loss, preventing SAE, and ensuring long-term compliance in order to avoid weight regain and malnutrition. 1-SICOB

Effectiveness of Online Aftercare Programs Following Intragastric Balloon Placement for Obesity Is Similar to Traditional Follow-up: a Large Propensity Matched US Multicenter Study.

The combination of intragastric balloons (IGB) with comprehensive lifestyle and behavioral changes is critical for ongoing weight loss. Many community and rural practices do not have access to robust obesity resources, limiting the use of IGBs. Online aftercare programs were developed in response to this need, delivering lifestyle coaching to maximize effectiveness. How these programs compare to traditional follow-up is currently unknown. Using propensity scoring(PS) methods, two large prospective databases of patients undergoing IGB therapy were compared to estimate the difference in percent total body weight loss (%TBWL) between groups while identifying predictors of response. Seven hundred fifty-eight unique patients across 78 different participating practices (online n = 437; clinical registry n = 321) was analyzed. The mean %TBWL at balloon removal was 11% ± 6.9 with an estimated treatment difference (ETD) between online and traditional follow-up of - 1.5% TBWL (95% CI - 3-0.4%; p = 0.125). Three months post-balloon removal, the combined %TBWL was 12.2% ± 8.3 with an ETD of only 1% TBWL (95%CI -3-3%; p = 0.08). On multivariable linear regression, each incremental follow-up was associated with increased %TBWL (β = 0.6% p = 0.002). Online IGB aftercare programs provide similar weight loss compared with traditional programs. Increased lifestyle coaching whether in person or remotely is associated with more %TBWL at removal and during follow-up. Close follow-up for clinical symptoms is still warranted.