Safety Of Endoscopic Sleeve Gastroplasty Research Articles

Comparable Short-Term Weight Loss and Safety of Endoscopic Sleeve Gastroplasty in Diabetic and Non-diabetic Patients.

Endoscopic sleeve gastroplasty (ESG) is a highly effective endo bariatric procedure. Data on outcomes of ESG in patients with diabetes mellitus (DM) compared to non-diabetics are limited. We aim to assess differences in clinical outcomes of ESG in DM patients in North America. We used the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database from 2016 to 2021 to identify all DM patients who underwent ESG as the primary procedure for weight loss. A 1:1 propensity score matched cohort of non-DM patients served as controls. Patient characteristics, clinical outcomes, and complications were compared and analyzed. Adult patients with Class I obesity and above were included. After matching, 310 DM and non-DM patients that underwent ESG were compared. The median % BMI decrease (3.3% vs. 3.1%, P = 0.62) and median total body weight loss (%TBWL) (4.3% vs. 4%, P = 0.75) in 30days were similar in the DM compared to non-DM cohorts. A similar proportion of patients with major adverse events (AEs) were presentafter ESG in the DM (1.6% vs. 1.3%, P = 0.74) compared to the non-DM cohort. The DM cohort had more patients with 30-day readmissions (3.2% vs. 1.9%, P = 0.08) than the non-DM cohort. %TBWL was similar in patients with HbA1c < 9% compared to ≥ 9%, (4.3% each, P = 0.33) with comparable AEs. ESG is a safe procedure in DM patients, without an increase in AEs, and it shows similar short-term weight loss compared to non-DM patients.

Endoscopic sleeve gastroplasty: early results of a minimally invasive procedure in patients with obesity.

We aimed to analyze the efficacy and safety of endoscopic sleeve gastroplasty at 3months as well as to determine factors influencing post-procedural weight loss. Seventy-three patients with obesity classes I, II and III (BMI 31.1-46.6kg/m2) underwent ESG between September 2021 and April 2022 at a tertiary care hospital using Overstitch (Apollo Endosurgery, Austin, TX). ESG's efficacy and safety was evaluated at 1 and 3months post-procedure with regard to excess weight loss (EWL) and total weight loss (TWL). Categorical variables were expressed as percentages and compared with chi-square test while continuous variables were expressed as mean ± standard deviation and compared with paired t test and analysis of variance (ANOVA) as applicable. Pearson's correlation was used to determine association between factors at baseline and weight loss. Mean age was 49.2 ± 9.7years with 61 (83.6%) patients being female. Mean initial weight was 105.7 ± 15.7kg, and mean BMI was 38.6 ± 3.5kg/m2. Median hospitalization was 2.0 ± 1.8days with 62 (84.9%) patients discharged after 24h. One patient had accidental suturing of the stomach to the abdominal wall and diaphragm which was managed laparoscopically. Mean %EWL was 25.4 ± 7.1 and 36.3 ± 11.4, and %TBWL was 11.2 ± 2.6 and 15.8 ± 4.2 at 1 and 3months, respectively. Significant excess weight loss at 3months was only observed in patients with BMI < 40kg/m2 (p = 0.001). ESG is safe and effective to manage obesity. Significant weight loss at 3months was only observed in patients with obesity class I and class II.

Endoscopic Sleeve Gastroplasty: A Safe Bariatric Intervention for Class III Obesity (BMI > 40).

Endoscopic sleeve gastroplasty (ESG) is primarily offered to patients with class I and II obesity (BMI 30-40), although there are no guidelines specifying applicability. There is little data comparing ESG to bariatric surgery in patients with class III obesity (BMI > 40). This study evaluates the short-term safety of ESG compared to sleeve gastrectomy (SG) and gastric bypass (RYGB) in patients with class III obesity. We retrospectively analyzed over 500,000 patients who underwent ESG, SG, and RNYGB from 2016 to 2020 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. ESG patients were stratified by BMI to compare outcomes between class I and II versus class III obese patients. Class III obese patients who underwent ESG were also propensity matched to SG and RNYGB patients for matched comparisons. Primary outcomes included adverse events (AE), readmissions, re-operations, and re-interventions within 30days. Secondary outcomes included procedure time, length of stay (LOS), and total body weight loss (%TBWL) at 30days. Among ESG patients, those with BMI > 40 had no difference in AE, readmissions, or re-interventions versus patients with BMI 30-40 (p > 0.05), while achieving greater %TBWL at 30days (p < 0.05). In comparison to surgery, ESG had similar AE to SG and less than RNYGB, while producing comparable %TBWL to SG and RNYGB at 30days. The feasibility and safety of ESG in patients with class III obesity are comparable to patients with class I and II obesity. Additionally, the safety of ESG in patients with class III obesity is comparable to SG and safer than RYGB. Endoscopic sleeve gastroplasty: a safe bariatric intervention for class III obesity (BMI > 40).

S1073 Endoscopic Sleeve Gastroplasty in Class III Obesity (BMI&gt;40): A Propensity-Matched, Retrospective Comparison of Short-Term Safety and Efficacy vs Bariatric Surgery

Introduction: Less than 1% of eligible patients undergo bariatric surgery, mainly due to apprehensions over adverse events. Endoscopic sleeve gastroplasty (ESG) may increase adoption of bariatric procedures while limiting potential procedural morbidity. Although there are no guidelines that specify applicability, ESG is still predominantly offered to patients with class I (BMI 30-35 kg/m2) and class II obesity (BMI 35-40 kg/m2). There is a lack of data evaluating ESG amongst its surgical bariatric alternatives in patients with class III obesity (BMI > 40 kg/m2). This is the largest study yet to assess short term (30d) safety and efficacy of ESG in patients with class III obesity and compare its performance to sleeve gastrectomy (SG) and Roux-en-Y bypass (RNYB). Methods: We retrospectively evaluated over 500,000 patients undergoing ESG, SG, and RNYB across 800 hospitals from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2016-2020. ESG patients were grouped by obesity class (Class III and Class I-II) and propensity matched to compare outcomes between groups. ESG patients with class III obesity were also propensity matched separately to SG and RNYB patients with class III obesity to compare outcomes. Outcomes measured at 30d included adverse events (AE), readmissions, reoperations, reinterventions, total body weight loss (TBWL), emergency room (ER) visits, and outpatient treatments for dehydration. Results: In patients who underwent ESG, there was no difference in AE, readmissions, reoperations, or reinterventions between Class III and Class I-II obesity cohorts (p >0.05). ESG led to greater mean %TBWL at 30d in Class III obesity versus Class I-II obesity (p< 0.05). For class III obese patients, ESG had similar AE to SG (p >0.05) and far less than RNYB (p< 0.05). ESG led to nearly identical mean %TBWL as SG and RNYB at 30d (p< 0.05). ESG patients had similar rates of readmissions and reoperations (p >0.05) compared to SG, but more reinterventions (p < 0.05). SG had more outpatient treatments for dehydration (p< 0.05) and ER visits (p< 0.05) than ESG. Compared to RNYB, ESG had fewer readmissions, reoperations, outpatient treatments for dehydration, and ER visits (p< 0.05). Conclusion: ESG is safe in class III obesity, with no difference in AE between obesity classes. The safety of ESG in class III obesity mirrored SG and exceeded RNYB, with comparable efficacy. Clinicians should consider expanding access to ESG regardless of BMI. Table 1. - Short-Term Safety and Efficacy of Endoscopic Sleeve Gastroplasty in Class III Obesity versus Bariatric Surgery ESG in Class III Obesity (n= 2,626) ESG in Class I-II Obesity (n= 2,626) P SG in Class III Obesity (n= 5,252) P RNYB in Class III Obesity (n= 5,252) P Mean BMI (SD) 47.79 (7.23) 35.38 (2.73) < 0.001 48.31 (7.44) 0.003 47.85 (6.84) 0.707 Mean Change from Pre-Op to Post-Op BMI (SD) -2.44 (3.42) -1.30 (1.84) < 0.001 -2.65 (2.29) 0.002 -2.58 (2.47) 0.057 Mean % Total Body Weight Loss at 30d (SD) 5.0 (6.0) 3.2 (7.3) < 0.001 5.4 (3.8) < 0.001 5.3 (4.4) 0.003 Mean Number of Days from Procedure to Discharge (SD) 1.01 (1.65) 0.73 (2.23) < 0.001 1.52 (1.33) < 0.001 1.94 (1.84) < 0.001 Mean Procedure Length, minutes (SD) 68.94 (49.15) 60.49 (44.48) < 0.001 78.99 (40.17) < 0.001 134.97 (65.25) < 0.001 Major Adverse Event, n (%) 36 (1.4) 37 (1.4) 1 76 (1.4) 0.866 172 (3.3) < 0.001 Anastomotic Leak, n (%) 0 (0.0) 0 (0.0) 1 1 (0.2) 0.808 2 (0.3) 0.718 Pneumonia, n (%) 2 (0.1) 7 (0.3) 0.182 9 (021) 0.784 24 (0.5) 0.01 Intra-operative or Post-operative Blood Transfusion, n (%) 11 (0.4) 15 (0.6) 0.555 25 (0.5) 0.859 68 (1.3) < 0.001 Mean Number of Blood Products Transfused (SD) 0.11 (0.87) 0.10 (0.56) 0.965 0.10 (0.56) 0.835 0.25 (1.05) 0.017 Vein Thrombosis requiring therapy, n (%) 0 (0.0) 2 (0.1) 0.479 12 (0.2) 0.032 10 (0.2) 0.057 Sepsis, n (%) 6 (0.2) 6 (0.2) 1 7 (0.1) 0.492 13 (0.2) 1 Unplanned Admission to ICU, n (%) 12 (0.5) 9 (0.3) 0.662 29 (0.6) 0.698 58 (1.1) 0.006 Bowel Obstruction, n (%) 1 (0.3) 0 (0.0) 1 2 (0.0) 0.883 6 (0.9) 0.383 Reoperation within 30 days, n (%) 32 (1.2) 33 (1.3) 1 53 (1.0) 0.464 138 (2.6) < 0.001 Readmission within 30 days, n (%) 101 (3.8) 92 (3.5) 0.557 179 (3.4) 0.355 334 (6.4) < 0.001 Reintervention within 30 days, n (%) 68 (2.6) 62 (2.4) 0.657 53 (1.0) < 0.001 125 (2.4) 0.624 Received Treatment for Dehydration Outpatient, n (%) 75 (2.9) 54 (2.1) 0.075 206 (3.9) 0.019 269 (5.1) < 0.001 Emergency Department Visit Not Resulting in Admission, n (%) 148 (5.6) 108 (4.1) 0.012 364 (6.9) 0.032 522 (9.9) < 0.001

Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial

Endoscopic sleeve gastroplasty (ESG) is an endolumenal, organ-sparing therapy for obesity, with wide global adoption. We aimed to explore the efficacy and safety of ESG with lifestyle modifications compared with lifestyle modifications alone. We conducted a randomised clinical trial at nine US centres, enrolling individuals aged 21-65 years with class 1 or class 2 obesity and who agreed to comply with lifelong dietary restrictions. Participants were randomly assigned (1:1·5; with stratified permuted blocks) to ESG with lifestyle modifications (ESG group) or lifestyle modifications alone (control group), with potential retightening or crossover to ESG, respectively, at 52 weeks. Lifestyle modifications included a low-calorie diet and physical activity. Participants in the primary ESG group were followed up for 104 weeks. The primary endpoint at 52 weeks was the percentage of excess weight loss (EWL), with excess weight being that over the ideal weight for a BMI of 25 kg/m2. Secondary endpoints included change in metabolic comorbidities between the groups. We used multiple imputed intention-to-treat analyses with mixed-effects models. Our analyses were done on a per-protocol basis and a modified intention-to-treat basis. The safety population was defined as all participants who underwent ESG (both primary and crossover ESG) up to 52 weeks. Between Dec 20, 2017, and June 14, 2019, 209 participants were randomly assigned to ESG (n=85) or to control (n=124). At 52 weeks, the primary endpoint of mean percentage of EWL was 49·2% (SD 32·0) for the ESG group and 3·2% (18·6) for the control group (p<0·0001). Mean percentage of total bodyweight loss was 13·6% (8·0) for the ESG group and 0·8% (5·0) for the control group (p<0·0001), and 59 (77%) of 77 participants in the ESG group reached 25% or more of EWL at 52 weeks compared with 13 (12%) of 110 in the control group (p<0·0001). At 52 weeks, 41 (80%) of 51 participants in the ESG group had an improvement in one or more metabolic comorbidities, whereas six (12%) worsened, compared with the control group in which 28 (45%) of 62 participants had similar improvement, whereas 31 (50%) worsened. At 104 weeks, 41 (68%) of 60 participants in the ESG group maintained 25% or more of EWL. ESG-related serious adverse events occurred in three (2%) of 131 participants, without mortality or need for intensive care or surgery. ESG is a safe intervention that resulted in significant weight loss, maintained at 104 weeks, with important improvements in metabolic comorbidities. ESG should be considered as a synergistic weight loss intervention for patients with class 1 or class 2 obesity. This trial is registered with ClinicalTrials.gov, NCT03406975. Apollo Endosurgery, Mayo Clinic.

ESG should be judged on its own merits

In The Lancet, Barham K Abu Dayyeh and colleagues present the results of their most recent trial (MERIT),1 assessing the efficacy and safety of endoscopic sleeve gastroplasty (ESG) to treat mild-to-moderate obesity. Abu Dayyeh himself first described ESG in 2013 as a novel transoral gastric plication method.2 The initial technique was based mainly on volume restriction achieved by apposition of the anterior and posterior gastric walls by means of separate interrupted stitches. As ESG diffused worldwide and the understanding of its physiology increased, technical refinements ensued.

Safety of Endoscopic Sleeve Gastroplasty with a Single-Channel Endoscope.

Less invasive endoscopic bariatric procedures are under development for the management of class I of obesity. The purpose of our study is to evaluate the safety of endoscopic sleeve gastroplasty (ESG) using the new suturing device OverStitch Sx™. This is a retrospective single-center study over 191 patients using the ESG under general anesthesia with overnight inpatient observation between January 2019 and December 2020. The analyzed variables were adverse effects and change in body weight at 6 and 12months of follow-up. A total of 191 patients underwent ESG for primary obesity. There were 173 female (90.6%) with a mean age of 36.9years. The mean BMI was 33.7kg/m2 (range: 28.9-54). There were no major intra-procedure adverse events. There were two postprocedural complications (1.04%), a transparietal suturing of falciform ligament which needed laparoscopic exploration for severe abdominal pain and a perigastric collection with antibiotic treatment, both with favorable outcome. Considering the weight loss results, the %TWL recorded was 22.4% for 84 patients (43.9%, 6months' follow-up) and 18.7% for 69 patients (36.1%, 12months' follow-up) with the mean EWL of 41.6% and respectively 34.7%. A total of 59 patients (30.9%) were lost follow-up and 12 patients underwent revisional bariatric procedure. According to ASGE definition, 53.8% (n = 71) reached > 25% of EWL. Endoscopic gastroplasty represents a safe minimal invasive approach with the new device OverStitch Sx™ that can be considered an effective and well-tolerated procedure especially for primary obesity treatment.

Efficacy and safety of endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy with 12+ months of adjuvant multidisciplinary support

BackgroundThe laparoscopic sleeve gastrectomy (LSG) and the incisionless endoscopic sleeve gastroplasty (ESG) weight loss procedures require further investigation of their efficacy, safety and patient-centered outcomes in the Australian setting.MethodsThe aim was to examine the 6- and 12-month weight loss efficacy, safety, and weight-related quality of life (QoL) of adults with obesity who received the ESG or LSG bariatric procedure with 12+ months of adjuvant multidisciplinary pre- and postprocedural support. Data were from a two-arm prospective cohort study that followed patients from baseline to 12-months postprocedure from a medical center in Queensland. Percent excess weight loss (%EWL) was the primary outcome. Secondary outcomes were body composition (fat mass, fat-free mass, android:gynoid ratio, bone mineral content) via dual energy X-ray absorptiometry, weight-related QoL, lipid, glycemic, and hepatic biochemistry, and adverse events.Results16 ESG (19% attrition; 81.2% female; aged:41.4 (SD: 10.4) years; BMI: 35.5 (SD: 5.2) kg/m2) and 45 LSG (9% attrition; 84.4% female; aged:40.4 (SD: 9.0) years; BMI: 40.7 (SD: 5.6) kg/m2) participants were recruited. At 12-months postprocedure, ESG %EWL was 57% (SD: 32%; p < 0.01) and LSG %EWL was 79% (SD: 24%; p < 0.001). ESG and LSG cohorts improved QoL (19.8% in ESG [p > 0.05]; 48.1% in LSG [p < 0.05]), liver function (AST: − 4.4 U/L in ESG [p < 0.05]; − 2.7 U/L in LSG [p < 0.05]), HbA1c (− 0.5% in ESG [p < 0.05]; − 0.1% in LSG [p < 0.05]) and triglycerides (− 0.6 mmol/L in ESG [p > 0.05]; − 0.4 mmol/L in LSG [P < 0.05]) at 12-months. Both cohorts reduced fat mass (p < 0.05). The ESG maintained but LSG decreased fat-free mass at 6-months (p < 0.05); and both cohorts lost fat-free mass at 12-months (p < 0.05). There were no adverse events directly related to the procedure. The ESG reported 25% mild-moderate adverse events possibly related to the procedure, and the LSG reported 27% mild-severe adverse events possibly related to the procedure.ConclusionsIn this setting, the ESG and LSG were safe and effective weight loss treatments for obese adults alongside multidisciplinary support. Patients who elected the ESG maintained fat-free mass at 6-months but both cohorts lost fat-free mass at 12-months postprocedure. Patients who elected the LSG had large and significant improvements to weight-related quality of life. Further well-powered studies are required to confirm these findings.Trial registrationThis study was registered prospectively at the Australia New Zealand Clinical Trials Registry on 06/03/2018, Registration Number ACTRN12618000337279.

Efficacy and safety of endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy in obese subjects with Non-Alcoholic SteatoHepatitis (NASH): study protocol for a randomized controlled trial (TESLA-NASH study)

BackgroundNon-alcoholic steatohepatitis (NASH) is frequently associated with obesity, and its standard treatment is weight loss with diet and exercise; a dy% weight reduction has been associated with improvement in liver histological and analytical abnormalities. However, less than 25% of subjects achieve this goal. Laparoscopic sleeve gastrectomy (LSG) represents the most common procedure of bariatric surgery, providing effective weight loss and improvement in comorbidities such as NASH, but it is associated with several postoperative complications. Endoscopic bariatric techniques are currently on the rise as a new tool in the fight against obesity, offering patients an alternative to more invasive surgery. However, their efficacy and safety compared with LSG is unclear.MethodsThe TESLA-NASH study is a randomized, controlled, open-label, unicentric clinical trial with a medical device. The aim of this study is to evaluate and compare the efficacy and safety of endoscopic sleeve gastroplasty (ESG) versus laparoscopic sleeve gastrectomy (LSG) in liver histology improvement of patients with obesity +/− metabolic syndrome and NASH. A total of 30 patients will be randomized 1:1 to the experimental or control group.DiscussionLSG is an effective treatment for weight reduction and for the remission of hepatic alterations. However, LSG is associated with acute and chronic postoperative complications. Bariatric endoscopic techniques promise less invasive and more cost-effective approaches to the treatment of obesity and metabolic comorbidities. ESG represents one of the most promising novel endoscopic interventions and it is mainly proposed for patients with mild-to-moderate obesity, but there are still no guidelines that specify its applicability criteria. This clinical trial will help us apply different tactics to the treatment of obesity and NASH.Trial registrationClinicalTrials.gov NCT04060368. Registered on Nov 15, 2019.

Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it?

ESG is an effective treatment for classes I and II obesity. However, the benefit of ESG in patients with morbid obesity (BMI ≥ 40kg/m2) who decline surgery is not known. The study aims to compare the effectiveness and safety of ESG in all three obesity classes at 1year. We reviewed 484 patient records and identified 435 patients (class I: 105, class II: 169, class III: 161) who underwent ESG at our unit between May 2013 and March 2020. We compared their total body weight loss (%TBWL) and safety over 1year. We used a linear mixed model (LMM) to analyse repeated measures of weight loss outcomes at 3, 6, 9, and 12months for comparison between the three BMI groups. Among the 435 patients, 396 patients (class I: 99, class II: 151, class III: 146) completed 6months, and 211 patients reached 1year (class I: 50, class II: 77, class III: 84). There was no difference in age between the groups. In LMM analysis, adjusting for age and sex, we found ESG had a significantly higher TBWL, %TBWL, and BMI decline in class III compared to classes I and -II obesity at all time points (p < 0.001). The adjusted mean %TBWL at 1year with classes I, -II, and -III obesity was 16.5%, 18.2%, and 20.5%, respectively. The overall complication rate and the hospital stay was identical in the three groups. ESG induced significant weight loss in all classes of obesity. In class III obesity, the weight loss achieved was significantly higher at 1year. In patients declining or unsuitable for surgery, ESG could be considered as an alternative treatment option.

The Efficacy and Safety of Endoscopic Sleeve Gastroplasty as an Alternative to Laparoscopic Sleeve Gastrectomy.

Endoscopic sleeve gastroplasty (ESG) is a therapeutic endoscopic technique for reducing the size of the gastric reservoir in obese patients, using a full-thickness endoscopic suturing device. The effectiveness of ESG in weight loss is significantly greater than that of high-intensity diet and lifestyle therapy and lower than that of laparoscopic sleeve gastrectomy (LSG). The efficacy at 12 months after ESG in terms of percentage of total body weight loss and excess body weight loss was approximately 16% and 60%, respectively. The well-known predictive factors for increased weight loss by ESG are good compliance with regular monitoring and post-procedure care involving a multidisciplinary team approach. Although the underlying mechanism of weight loss induced by ESG is debatable, delayed gastric emptying and early satiation are some of the proposed mechanisms. The pooled rate of adverse events after ESG reported in several meta-analysis studies ranged from 1.5% to 2.3% and the incidence of new-onset gastroesophageal reflux disease after ESG was negligible, indicating that ESG has a superior safety profile to LSG. Moreover, ESG reduced the risk of obesity-related metabolic comorbidities, evidenced by the reduction in HbA1c level, systolic blood pressure, triglyceride level, and risk of hepatic steatosis and fibrosis; it even improved the quality of life. ESG could be considered safe and qualify as an alternative treatment to LSG.

Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?

Endoscopic sleeve gastroplasty (ESG) is an effective treatment option for obesity. However, data comparing its efficacy to bariatric surgery are scarce. We aimed to compare the effectiveness and safety of ESG with laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curve plication (LGCP) at 2 years. METHODS : We reviewed 353 patient records and identified 296 patients who underwent ESG (n = 199), LSG (n = 61), and LGCP (n = 36) at four centers in Spain between 2014 and 2016. We compared their total body weight loss (%TBWL) and safety over 2 years. A linear mixed model (LMM) was used to analyze repeated measures of weight loss outcomes at 6, 12, 18, and 24 months to compare the three procedures. RESULTS : Among the 296 patients, 210 (ESG 135, LSG 43, LGCP 32) completed 1 year of follow-up and 102 (ESG 46, LSG 34, LGCP 22) reached 2 years. Their mean (standard deviation [SD]) body mass index (BMI) was 39.6 (4.8) kg/m2. There were no differences in age, sex, or BMI between the groups. In LMM analysis, adjusting for age, sex, and initial BMI, we found ESG had a significantly lower TBWL, %TBWL, and BMI decline compared with LSG and LGCP at all time points (P = 0.001). The adjusted mean %TBWL at 2 years for ESG, LSG, and LGCP were 18.5 %, 28.3 %, and 26.9 %, respectively. However, ESG, when compared with LSG and LGCP, had a shorter inpatient stay (1 vs. 3 vs. 3 days; P < 0.001) and lower complication rate (0.5 % vs. 4.9 % vs. 8.3 %; P = 0.006). CONCLUSION : All three procedures induced significant weight loss in obese patients. Although the weight loss was lower with ESG compared with other techniques, it displayed a better safety profile and shorter hospital stay.

Exam 1: Efficacy and Safety of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis

Exam 1: Efficacy and Safety of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis

Efficacy and Safety of Endoscopic Sleeve Gastroplasty at Mid Term in the Management of Overweight and Obese Patients: a Systematic Review and Meta-Analysis.

Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78kg/m2. Pooled mean %TWL observed at 6, 12, and 18months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.

Endoscopic sleeve gastroplasty is an effective and safe minimally invasive approach for treatment of obesity: First Indian experience.

Endoscopic sleeve gastroplasty (ESG) is gaining acceptance as a non-surgical option for the treatment of obesity. However, its role is still not consolidated for all populations and the ideal indications are yet to be determined. We aimed to study the efficacy and safety of ESG in Indian patients. We conducted a single-center retrospective study of obese patients who underwent consecutive ESG at our tertiary care center. Data on weight loss and adverse events at 1, 3, 6, and 12months were collected and analyzed. Fifty-three patients underwent ESG from March 2017 to October 2018. Eighty one percent of patients were female (43/53). Mean baseline age and body mass index were 40.54 ± 13.79years and 34.78 ± 5.20kg/m2 , respectively. Mean duration of procedure was 68.96±11.19min. Immediate postoperative complications included mainly epigastric pain (45.2%) and nausea (22.6%) but there was no serious adverse event. Average percentage of total weight loss (%TWL) was 8.26%, 11.96%, 14.25%, and 19.94% at 1, 3, 6, and 12months, respectively. Eighty-eight percent of patients achieved >15% TWL at 12months. Younger patients (<30years old) and female patients had greater %TWL at 12months (P=0.01 and P=0.021, respectively). Last 18 procedures were significantly faster than the first 35 cases (P=0.01). Endoscopic sleeve gastroplasty is effective and safe at promoting weight loss in the Indian population. Young age and female gender are related to better outcomes.

Efficacy and safety of endoscopic sleeve gastroplasty for obesity patients: a meta-analysis.

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive, effective, and safe technique for weight loss intervention. Since a relatively small number of cases were present in previous studies, this study aimed to elucidate the efficacy and safety of ESG. Relevant publications were identified through searching PubMed, EMBASE, Cochrane, and Web of Science before March 1, 2019. The percentage of total body weight loss (%TBWL), percentage of excess weight loss (%EWL), and the adverse event rate in each follow-up session were extracted, pooled, and analyzed. Forest plots were graphed based on random effects models. A total of 1542 patients from nine studies were eligible for analysis. The pooled results of %TBWL at 1, 3, 6, and 12months were 8.78% (p = 0.000), 11.85% (p = 0.000), 14.47% (p = 0.024), and 16.09% (p = 0.063), respectively. The pooled results of %EWL at 1, 3, 6, and 12months were 31.16% (p = 0.000), 43.61% (p = 0.000), 53.14% (p = 0.000), and 59.08% (p = 0.015), respectively. Finally, the pooled rate of mild adverse events was 72% (p < 0.01), and the pooled estimate of severe adverse events was only 1% (p = 0.08). Although the conventional surgical sleeve gastrectomy is the gold standard for bariatric surgery, ESG could be a promising minimally invasive alternative for treating obesity with satisfactory efficacy and low risk.

Sa2023 Efficacy and Safety of Endoscopic Sleeve Gastroplasty (ESG) as a Primary Endoscopic Obesity Treatment

Sa2023 Efficacy and Safety of Endoscopic Sleeve Gastroplasty (ESG) as a Primary Endoscopic Obesity Treatment