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Abdulla M, Mohammed N, AlQamish J, Arau RT. Efficacy and safety of endoscopic gastroplasty for treatment of obesity: An overview of comparative meta-analyses. World J Gastrointest Endosc 2025; 17:105158. [PMID: 40438714 PMCID: PMC12110147 DOI: 10.4253/wjge.v17.i5.105158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Revised: 03/10/2025] [Accepted: 04/22/2025] [Indexed: 05/12/2025] Open
Abstract
BACKGROUND There is a scarcity of evidence and systematic reviews on endoscopic gastroplasty (EG) compared to other management options for the treatment of obesity. AIM To assess the published meta-analyses through a systematic review approach and provide further insight into the current status of available evidence through a critical appraisal. METHODS PubMed/MEDLINE, Scopus, Embase and Cochrane Library were searched from inception to November 2022. The meta-analyses that compared the efficacy and safety of EG to other interventions were considered for this overview. The outcomes of interest were total body weight loss (TBWL), excessive weight loss, and average weight loss along with occurrence of adverse effects. Methodological quality, heterogeneity, and limitations were also reviewed. RESULTS A total of six meta-analyses out of 364 records were considered for this review with a major contribution from the United States. Overall methodological quality of included studies were moderate to good. EG treatments were significantly better in terms of TBWL, excessive weight loss, and average weight loss. However, there was no significant difference between endoscopic transoral outlet reduction and full-thickness suturing plus argon plasma mucosal coagulation. Lack of comparative studies and randomized trials, lack of long-term follow-up, reporting bias, selection bias, lack of control groups, and considerable level of heterogeneity were the major limitations in the available evidence. CONCLUSION Though EG was significantly effective for treatment of obesity, there is limited comparative evidence on this topic. High-quality well-controlled evidence is required to strengthen the current evidence base on EG treatment for obesity.
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Affiliation(s)
- Maheeba Abdulla
- Department of Internal Medicine, Ibn Al Nafees Hospital, Manama 54533, Bahrain
| | - Nafeesa Mohammed
- Department of Intensive Care Unit, Salmaniya Medical Complex, Manama 5616, Bahrain
| | - Jehad AlQamish
- Department of Internal Medicine, Ibn Al Nafees Hospital, Manama 54533, Bahrain
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Mocanu V, Jordan E, Dang J, Shin T. Comparing Endoscopic Sleeve Gastroplasty (ESG) and Laparoscopic Sleeve Gastrectomy (LSG) 30-Day Outcomes and Healthcare Utilization: A Multi-Centered Retrospective Cohort Study of 506,597 Patients. Obes Surg 2025:10.1007/s11695-025-07893-7. [PMID: 40293629 DOI: 10.1007/s11695-025-07893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 03/25/2025] [Accepted: 04/23/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND While the safety and short-term weight-loss outcomes of endoscopic sleeve gastroplasty (ESG) are now well accepted, the modern uptake and its impact on healthcare utilization continue to remain poorly characterized, particularly in contrast to laparoscopic sleeve gastrectomy (LSG). METHODS After identifying ESG and LSG cases using a combination of CPT and procedural code variables, non-parsimonious multivariable logistic regression models were conducted to identify predictors of serious complications and outpatient emergency department (ED) visits. RESULTS A total of 506,597 patients met inclusion criteria (2285 ESG and 504,312 LSG). ESG patients were younger (42.6 ± 11.8 years versus 45.1 ± 10.7 years, p < 0.0001), had a lower BMI (39.5 ± 7.5 kg/m2 versus 44.9 ± 7.7 kg/m2, p < 0.0001), and were primarily female (86.2% versus 81.5%, p < 0.0001). Multivariable regression modeling revealed no differences in serious complications between ESG and LSG. ESG was protective against ED visits (OR 0.66; 95% 0.54-0.80; p < 0.0001). There were no other differences with respect to mortality or other healthcare metrics, such as outpatient rehydration, between procedures. CONCLUSIONS Multivariable logistic regression modeling of prospectively collected 30-day outcomes in a large multi-institutional database demonstrates that ESG does not confer additional risk of 30-day serious complications compared to LSG and has lower odds off post-procedural ED utilization in the same comparison.
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Affiliation(s)
| | - Emily Jordan
- University of Virginia, Charlottesville, United States
| | - Jerry Dang
- Cleveland Clinic, Cleveland, United States
| | - Thomas Shin
- University of Virginia, Charlottesville, United States.
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Baratte C, Sebbag H, Arnalsteen L, Auguste T, Blanchet MC, Benchetrit S, Abou-Mrad A, Reche F, Genser L, Caiazzo R, Lazzati A, Catheline JM, Pourcher G, Leyre P, Kamoun-Zana S, Stenard F, Coste T, Sterkers A, Blanchard C, Poghosyan T, Pattou F, Perretta S, Robert M. Position statement and guidelines about Endoscopic Sleeve Gastroplasty (ESG) also known as "Endo-sleeve". J Visc Surg 2025; 162:71-78. [PMID: 39794164 DOI: 10.1016/j.jviscsurg.2024.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2025]
Abstract
IS ESG EFFECTIVE IN THE TREATMENT OF OBESITY AND ASSOCIATEDCOMORBIDITIES?: Endoscopic Sleeve Gastroplasty (ESG) is more effective than lifestyle modifications alone for weight loss and improving obesity-related comorbidities. While it has less effect on weight loss compared to Laparoscopic Sleeve Gastrectomy (LSG) in the short to medium term, it offers similar comorbidities resolution to LSG. IS ESG A SAFE PROCEDURE, AND WHAT ARE ITS RISKS?: The safety profile of ESG is consistently supported in the literature. Surgical complications after ESG, ranging from 1.5 to 2.3%, such as bleeding, perforation, fistula, or upper bowel obstruction, are rare and typically managed endoscopically. The incidence of new-onset gastro-esophageal reflux disease (GERD) is deemed negligible and occurs less frequently after ESG compared to SG. WHAT ARE THE INDICATIONS AND MANAGEMENT METHODS?: Multidisciplinary care for patients undergoing ESG should be provided in an accredited center authorized to perform bariatric and metabolic surgery, with validation through a multidisciplinary consultation meeting (RCP). Perioperative management should be personalized and ideally modeled after the protocols already in place for bariatric and metabolic surgery to ensure satisfactory and lasting weight and metabolic outcomes. Adherence to follow-up visits is a significant predictor of successful weight loss outcomes after ESG. Additionally, all endoscopic surgical procedures should be documented in a registry affiliated with a recognized scientific society, as is standard for other bariatric surgical procedures. WHICH HEALTHCARE PROFESSIONALS CAN PERFORM ESG?: ESG must be performed by a practitioner trained in endoscopy and obesity management, capable of ensuring thorough preoperative care and comprehensive postoperative follow-up, supported by an experienced multidisciplinary team. In France, Notice No. 2021.0040/AC/SEAP of June 10, 2021, issued by the Haute Autorité de santé (HAS) college, specifies that "the technology of ESG via the trans-oral approach, involving wide plication of the greater gastric curvature […] with an endoscopic suture placement device, enables a gastroenterologist or a visceral and digestive surgeon to perform gastric plication through digestive endoscopy by placing sutures in the stomach". Ideally, this should take place in an accredited center authorized to perform bariatric and metabolic surgery, such as those approved by the Agence régionale de santé (ARS), in accordance with Article R6123-212 of December 2022 of the French Public Health Code. WHAT ARE THE RECOMMENDATIONS AND VIEWS OF OTHER INTERNATIONAL SCIENTIFICSOCIETIES?: ESG is an integral part of the therapeutic arsenal available to bariatric and metabolic surgeons, offering an effective and valuable treatment option for obesity in specific patient populations. The International Federation for the Surgery of Obesity (IFSO) Bariatric Endoscopy Committee, following a comprehensive systematic review and meta-analysis, endorsed ESG as an effective and valuable treatment for obesity. ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. Additionally, it can be proposed as an addition to lifestyle interventions in adolescent patients with class II obesity. The SOFFCOMM endorses endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity and highlights the importance of appropriate patient selection, coupled with rigorous evaluation of long-term outcomes, to refine its indications further.
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Affiliation(s)
- Clément Baratte
- Department of General, Digestive, Bariatric and Oesogastric SurgeryUniversity of Paris, centre de recherche sur l'inflammation UMR 1149, hôpital Bichat - Claude-Bernard, Assistance publique-Hôpitaux de Paris, Inserm, 46, rue Henri-Huchard, 75018 Paris, France
| | - Hugues Sebbag
- Hôpital privé de Provence, 200, allée Nicolas-de-Staël, 13080 Aix-en-Provence, France
| | | | - Thomas Auguste
- Hôpital privé Océane, 11, rue Dr-Joseph-Audic, 56000 Vannes, France
| | - Marie-Cécile Blanchet
- Department of Digestive and Bariatric Surgery, centre lyonnais de chirurgie digestive, CSO Sauvegarde, Lyon, France
| | | | - Adel Abou-Mrad
- Centre Hospitalier Universitaire d'Orléans, 14, avenue de l'Hôpital, 45100 Orléans - Loiret, France
| | - Fabian Reche
- CHU de Grenoble-Alpes, Grenoble-Alpes University, Grenoble-Alpes, France
| | - Laurent Genser
- Department of Hepato-Biliary and Pancreatic Surgery, Assistance publique-Hôpitaux de Paris, AP-HP, Sorbonne University, Pitié-Salpêtrière University Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Robert Caiazzo
- Hôpital Claude-Huriez, CHU de Lille, université de Lille, U1190, Lille, France
| | - Andrea Lazzati
- Digestive Surgery Department, Avicenne Hospital, 93000 Bobigny, France
| | | | - Guillaume Pourcher
- National Academy of Surgery, 15, rue de l'école de médecine, 75006 Paris, France; French Obesity Institute, Ramsay santé France, hôpital privé Geoffroy-St-Hilaire, 75005 Paris, France
| | - Pierre Leyre
- General and Digestive Surgery, hopital privé la Casamance, 13400 Aubagne, France
| | | | - Fabien Stenard
- Clinique des Cèdres, 21, rue Albert-Londres, 38130 Échirolles, France
| | - Thibaut Coste
- Polyclinique Sainte-Thérès, 6, quai du mas Coulet, 34200 Sète, France
| | - Adrien Sterkers
- Digestive Surgery, CHP Saint-Gregoire, CSO Bretagne, 6, boulevard de la Boutiere, 35760 St Gregoire, France
| | | | - Tigran Poghosyan
- Department of General, Digestive, Bariatric and Oesogastric SurgeryUniversity of Paris, centre de recherche sur l'inflammation UMR 1149, hôpital Bichat - Claude-Bernard, Assistance publique-Hôpitaux de Paris, Inserm, 46, rue Henri-Huchard, 75018 Paris, France
| | - François Pattou
- Hôpital Claude-Huriez, CHU de Lille, université de Lille, Inserm U1190, Lille, France.
| | - Silvana Perretta
- Department of Digestive and Endocrine Surgery, IHU-Strasbourg, Strasbourg University, Strasbourg, France
| | - Maud Robert
- Digestive Surgery, UFR Lyon Esthôpital Edouard-Herriot, hospices civils de Lyon, université Lyon 1, Lyon, France; Center spécialisé et intégré de l'obésité, Carmen Laboratory, Team 1, Inserm Unit, 1060 Lyon, France
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Malik A, Malik MI, Javaid S, Qureshi S, Nadir A. Comparative effectiveness of metabolic and bariatric surgeries: a network meta-analysis. Int J Obes (Lond) 2025; 49:54-62. [PMID: 39397157 DOI: 10.1038/s41366-024-01648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 08/31/2024] [Accepted: 10/03/2024] [Indexed: 10/15/2024]
Abstract
Bariatric surgery is recommended for patients with unhealthy weight. Our study aim to compare and rank different bariatric surgical approaches in reducing weight parameters. We searched MEDLINE, Cochrane CENTRAL, Scopus, and Web of Science databases from inception to September 2023. We extracted all outcomes as mean change from the baseline. The mean difference and 95% confidence interval were used as a summary measure. All analysis was conducted with R version 4.2.2 (2022-10-31) and R Studio version 2022.07.2 (2009-2022) (RStudio, Inc.). Included surgeries were: Biliopancreatic diversion (BPD-RYGB), Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Gastric Plication (LGP), Duodenal-Jejunal Bypass Sleeve (DJBS), Single-anastomosis gastric bypass (SAGB), Laparoscopic vertical banded gastroplasty (LVBG), Sleeve Gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Gastric plication, Biliopancreatic diversion (BPD), and Intra-gastric balloon (IGB). Only clinical trials were included, with outcomes focused on weight parameters such as reductions in BMI (kg/m²), weight (kg), waist circumference (cm), fat mass (kg), and excess weight loss (EWL) (%). Our analysis of 67 studies showed that SADI-S was the best surgical technique in decreasing BMI (kg/m2) (MD = -18.06; 95% CI [-25.31; -10.81]) and DS follows in efficacy with a P-score (MD = -18.88; 95% CI [-31.15; -6.62]) however the pooled analysis was heterogeneous (I2 = 98.5%). For weight (kg), waist circumference (cm), and fat mass (kg), BPD-RYGB was the best surgical technique to reduce these parameters (MD = -41.48; 95% CI [-47.80, -35.51], MD = -29.08; 95% CI [-37.16, -21.00], and MD = -31.11; 95% CI [-38.77, -23.46]; respectively). The pooled analysis was heterogeneous except in fat mass (I2 = 0%, p-value = 0.8). Our network meta-analysis showed that the best surgical technique in increasing EWL (%) was RY-DS (MD = -61.27; % CI [-91.72; -30.82]) the next one in efficacy according to P-score was LVBG (MD = -59.03; % CI [-84.47; -33.59]). SADI-S is most effective in reducing BMI followed by RYGB. DS was associated with most estimated weight loss %.
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Affiliation(s)
- Adnan Malik
- Mountain Vista Medical Center, Mesa, AZ, USA.
| | | | | | | | - Abdul Nadir
- Mountain Vista Medical Center, Mesa, AZ, USA
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Brunaldi VO, Galvao Neto M, Sharaiha RZ, Hoff AC, Bhandari M, McGowan C, Ujiki MB, Kedia P, Ortiz E, VanderWel B, Abu Dayyeh BK. Endoscopic sleeve gastroplasty as an early tool against obesity: a multicenter international study on an overweight population. Gastrointest Endosc 2024; 99:371-376. [PMID: 37852330 DOI: 10.1016/j.gie.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/15/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND AIMS Endoscopic sleeve gastroplasty (ESG) is an effective, minimally invasive gastric remodeling procedure to treat mild and moderate obesity. Early adoption of ESG may be desirable to try to halt progression of obesity, but there are few data on its efficacy and safety for overweight patients. METHODS This was a multicenter, international, analytical case series. Six U.S., 1 Brazilian, 1 Mexican, and 1 Indian center were included. Overweight patients according to local practice undergoing ESG were considered eligible for the study. The end points were percent total weight loss (%TWL), body mass index (BMI) reduction, rate of BMI normalization, and rate of adverse events. RESULTS One hundred eighty-nine patients with a mean age of 42.6 ± 14.1 years and a mean BMI of 27.79 ± 1.17 kg/m2 were included. All procedures were successfully accomplished, and there were 3 intraprocedural adverse events (1.5%). The mean %TWL was 12.28% ± 3.21%, 15.03% ± 5.30%, 15.27% ± 5.28%, and 14.91% ± 5.62% at 6, 12, 24, and 36 months, respectively. At 12 and 24 months, 76% and 86% of patients achieved normal BMI, with a mean BMI reduction of 4.13 ± 1.46 kg/m2 and 4.25 ± 1.58 kg/m2. There was no difference in mean %TWL in the first quartile versus the fourth quartile of BMI in any of the time points. However, the BMI normalization rate was statistically higher in the first group at 6 and 12 months (6 months, 100% vs 48.5% [P < .01]; 12 months, 86.2% vs 50% [P < .01]; 24 months, 84.6% vs 76.1% [P = .47]; 36 months, 86.3% vs 66.6% [P = .26]). CONCLUSIONS ESG is safe and effective in treating overweight patients with high BMI normalization rates. It could help halt or delay the progression to obesity.
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Affiliation(s)
| | - Manoel Galvao Neto
- Mohak Bariatric and Robotic Center, Indore, India; Elias Ortiz & Company, Tijuana, Mexico; Endovitta Institute, São Paulo, Brazil
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | | | | | | | - Michael B Ujiki
- Department of Surgery, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | | | - Barham K Abu Dayyeh
- Gastroenterology and Hepatology Division, Mayo Clinic, Rochester, Minnesota, USA.
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Gala K, Brunaldi V, McGowan C, Sharaiha RZ, Maselli D, Vanderwel B, Kedia P, Ujiki M, Wilson E, Vargas EJ, Storm AC, Abu Dayyeh BK. Performance of Endoscopic Sleeve Gastroplasty by Obesity Class in the United States Clinical Setting. Clin Transl Gastroenterol 2024; 15:e00647. [PMID: 37787450 PMCID: PMC10810569 DOI: 10.14309/ctg.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Endoscopic sleeve gastroplasty (ESG) has gained popularity over the past decade and has been adopted in both academic and private institutions globally. We present outcomes of the largest cohort of patients from the United States undergoing ESG and evaluate these according to obesity class. METHODS We performed a retrospective analysis of adult patients who underwent ESG. Medical information was abstracted from the electronic record with weight records up to 2 years after ESG. Percent total body weight loss (%TBWL) at 6, 12, 18, and 24 months was calculated based on baseline weight at the procedure. SPSS (version 29.0) was used for all statistical analyses. RESULTS A total of 1,506 patients from 7 sites were included (501 Class I obesity, 546 Class II, and 459 Class III). Baseline demographics differed according to obesity class due to differences in age, body mass index (BMI), height, sex distribution, and race. As early as 6 months post-ESG, mean BMI for each class dropped to the next lower class and remained there through 2 years. %TWBL achieved in the Class III group was significantly greater when compared with other classes at all time points. At 12 months, 83.2% and 60.9% of patients had ≥10% and ≥15% TBWL for all classes. There were no differences in adverse events between classes. DISCUSSION Real-world data from a large cohort of patients of all BMI classes across the United States shows significant and sustained weight loss with ESG. ESG is safe to perform in a higher obesity class with acceptable midterm efficacy.
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Affiliation(s)
- Khushboo Gala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitor Brunaldi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Reem Z. Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | | | | | | | - Michael Ujiki
- NorthShore University Health System, Evanston, Illinois, USA
| | - Eric Wilson
- University of Texas Health Science Center—Houston, Houston, Texas, USA
| | - Eric J. Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C. Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Hajifathalian K, Simmons O, Abu-Hammour M, Hassan K, Sharaiha RZ. Efficacy of endoscopic resuturing versus pharmacotherapy to treat weight recidivism after endoscopic sleeve gastroplasty. Gastrointest Endosc 2023; 98:944-949. [PMID: 37473967 DOI: 10.1016/j.gie.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND AIMS A subset of patients experience weight recidivism after primary endoscopic sleeve gastroplasty (P-ESG). Available options for management of weight regain include initiation of antiobesity medications (AOMs) or redo ESG (R-ESG). The comparative effectiveness of these options is not clear. METHODS This was a retrospective analysis of a prospectively maintained database of patients undergoing ESG. From 2013 to 2021, 79 patients who were started on AOM or underwent R-ESG for management of weight recidivism after P-ESG were included. The primary outcome of this study was final total body weight loss (TBWL) at the end of follow-up. RESULTS Fifty-five patients were started on AOM and 24 patients underwent R-ESG. Age, gender distribution, and baseline body mass index did not differ significantly between groups. The proportion of noncompliant patients (defined as patients who missed their first post-ESG follow-up visit) was significantly higher in the AOM group compared with the R-ESG group (67% vs 35%, P = .012). The additional TBWL after R-ESG was significantly (both clinically and statistically) better than after initiation of AOM (9.5% ± 7.2% vs 2.1% ± 8.6%, respectively; P = .001). Final TBWL clearly favored R-ESG over AOM for treatment of weight recidivism (19.9% ± 10.4% vs 13.6% ± 9.2%, P = .028). CONCLUSIONS R-ESG is an effective treatment to induce weight loss after experiencing weight recidivism. These results highlight an important advantage of ESG as a repeatable minimally invasive procedure.
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Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA
| | - Okeefe Simmons
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Mohamed Abu-Hammour
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Kamal Hassan
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
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Docimo S, Aylward L, Albaugh VL, Afaneh C, El Djouzi S, Ali M, Altieri MS, Carter J. Endoscopic sleeve gastroplasty and its role in the treatment of obesity: a systematic review. Surg Obes Relat Dis 2023; 19:1205-1218. [PMID: 37813705 DOI: 10.1016/j.soard.2023.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Salvatore Docimo
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida, Tampa, Florida.
| | - Laura Aylward
- Rockefeller Neuroscience Institute, West Virginia University of Medicine, Morgantown, West Virginia
| | - Vance L Albaugh
- Department of Metabolic Surgery, Pennington Biomedical Research Center, Metamor Institute, Baton Rouge, Louisiana
| | - Cheguevara Afaneh
- Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | | | - Mohamed Ali
- Department of Surgery, UC Davis Health, University of California, Davis, Davis, California
| | | | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, San Francisco, California
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Sharaiha RZ, Shikora S, White KP, Macedo G, Toouli J, Kow L. Summarizing Consensus Guidelines on Obesity Management: A Joint, Multidisciplinary Venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO). J Clin Gastroenterol 2023; 57:967-976. [PMID: 37831466 PMCID: PMC10566600 DOI: 10.1097/mcg.0000000000001916] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Reem Z. Sharaiha
- Department of Gastroenterology, Weill Cornell Medical College, New York, NY
| | - Scott Shikora
- Center for Metabolic and Bariatric Surgery, Brigham and Women’s Hospital Harvard Medical School, Boston, MA
| | - Kevin P. White
- ScienceRight International Health Research Consulting (SRIHRC), London, ON, Canada
| | - Guilherme Macedo
- Department of Gastroenterology & Hepatology, São João University Hospital Center, Porto, Portugal
| | - Jim Toouli
- Department of Surgery, Flinders University, Adelaide, SA, Australia
| | - Lillian Kow
- Department of Surgery, Flinders University, Adelaide, SA, Australia
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Shenoy A, Schulman AR. Advances in endobariatrics: past, present, and future. Gastroenterol Rep (Oxf) 2023; 11:goad043. [PMID: 37483864 PMCID: PMC10361810 DOI: 10.1093/gastro/goad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023] Open
Abstract
The obesity epidemic in the USA and worldwide is well documented and continues to grow. Endoscopic metabolic and bariatric therapies may offer a less invasive approach than surgical intervention. This article will review advances in endobariatrics over the last several decades, addressing the past and current state of bariatric and metabolic endoscopy. Food and Drug Administration-cleared devices and interventions currently under investigation are described including gastric devices, gastric remodeling procedures, small-bowel devices, duodenal ablation, as well as procedures to address weight regain after bariatric surgery. Future studies evaluating gastric and duodenal combination therapy, adjunctive pharmacotherapy, as well as individualized precision-health algorithms are underway.
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Affiliation(s)
- Abhishek Shenoy
- Corresponding author. Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48105, USA. Tel: +1-908-3381691; Fax: +1-734-9365458;
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
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Nduma BN, Mofor KA, Tatang J, Amougou L, Nkeonye S, Chineme P, Ekhator C, Ambe S. Endoscopic Sleeve Gastroplasty (ESG) Versus Laparoscopic Sleeve Gastroplasty (LSG): A Comparative Review. Cureus 2023; 15:e41466. [PMID: 37426405 PMCID: PMC10325692 DOI: 10.7759/cureus.41466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/11/2023] Open
Abstract
Obesity is one of the most debilitating conditions. In a quest to mitigate disease severity, various interventions have been proposed, with endoscopic sleeve gastroplasty (ESG) and laparoscopic sleeve gastroplasty (LSG) being among the recent interventions that have received growing attention. This systematic review sought to conduct a comparative analysis regarding the efficacy, effectiveness, and safety of both interventions. The study involved a systematic review in which key search engines were used to select articles documented and published in the last decade. The articles for inclusion were those existing as peer-reviewed studies touching upon the aforementioned subject, with both controlled and uncontrolled trials included. Furthermore, there was the implementation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol that governs systematic reviews, in which the article selection process entailed four key procedures in the form of identification, screening, determining eligibility, and the inclusion process. In the findings, the selected articles documented mixed outcomes, but a common denominator was that the safety profile of ESG tends to be superior to that of LSG due to the observations that ESG comes with fewer adverse events such as gastroesophageal reflux disease (GERD) and severe nausea and vomiting. However, the majority of the studies contended that LSG proved superior to ESG in terms of effectiveness and efficacy. Hence, individuals with mild-to-moderate obesity are more likely to benefit from ESG, but those with severe obesity whose goal is to achieve long-term weight management might benefit more from LSG. In conclusion, the management of obesity and the decision to employ ESG or LSG ought to be patient-centered and dictated by factors such as patient preferences, safety, and the sustainability of the devised plan of care.
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Affiliation(s)
- Basil N Nduma
- Internal Medicine, Merit Health Wesley, Hattiesburg, USA
| | - Kelly A Mofor
- Gastroenterology, Texas Tech Paul L Foster School of Medicine, El Paso, USA
| | - Jason Tatang
- Gastroenterology, Sam Houston State University, Huntsville, USA
| | - Loica Amougou
- Gastroenterology, School of Natural Sciences and Mathematics, University of Texas at Dallas, Richardson, USA
| | - Stephen Nkeonye
- Health & Biomedical Sciences, University of Texas Rio Grande Valley, Edinburg, USA
| | - Princess Chineme
- Gastroenterology, University of Texas at San Antonio, San Antonio, USA
| | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, New York, USA
| | - Solomon Ambe
- Neurology, Baylor Scott & White Health, Mckinney, USA
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12
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Vargas EJ, Rizk M, Gomez-Villa J, Edwards PK, Jaruvongvanich V, Storm AC, Acosta A, Lake D, Fidler J, Bharucha AE, Camilleri M, Abu Dayyeh BK. Effect of endoscopic sleeve gastroplasty on gastric emptying, motility and hormones: a comparative prospective study. Gut 2023; 72:1073-1080. [PMID: 36241388 PMCID: PMC10102256 DOI: 10.1136/gutjnl-2022-327816] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Endoscopic sleeve gastroplasty (ESG) has gained global adoption but our understanding of its mechanism(s) of action and durability of efficacy is limited. We sought to determine changes in gastric emptying (GE), gastric motility (GM), hormones and eating behaviours after ESG. DESIGN A priori-designed single-centre substudy of a large US randomised clinical trial, adults with obesity were randomised to ESG or lifestyle interventions (LS) alone. We measured GE, hormones and weight loss and assessed eating behaviours. In a subset of ESG patients, we assessed GM. The primary outcome was the change in T1/2 (min) at 3 months, and secondary outcomes were changes in weight, GE, GM, hormones and eating behaviours. We used t-test analyses and regression to determine the association between GE and weight loss. RESULTS 36 (ESG=18; LS=18) participated in this substudy. Baseline characteristics were similar between the two groups. At 3 months, T1/2 was delayed in the ESG group (n=17) compared with the LS group (n=17) (152.3±47.3 vs 89.1±27.9; p<0.001). At 12 months, T1/2 remained delayed in the ESG group (n=16) vs control group (n=14) (137±37.4 vs 90.1±23.4; p<0.001). Greater delays in GE at 3 months were associated with greater weight loss. GM was preserved and fasting ghrelin, glucagon-like peptide 1 and polypeptide YY significantly increased 18 months after ESG. CONCLUSION ESG promotes weight loss through several key mechanistic pathways involving GE and hormones while preserving GM. These findings further support clinical adoption of this technique for the management of obesity. TRIAL REGISTRATION NUMBER NCT03406975.
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Affiliation(s)
- Eric J Vargas
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Monika Rizk
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jacky Gomez-Villa
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Phillip K Edwards
- Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Veeravich Jaruvongvanich
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andrew C Storm
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andres Acosta
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David Lake
- Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff Fidler
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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13
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Camilleri M, El-Omar EM. Ten reasons gastroenterologists and hepatologists should be treating obesity. Gut 2023; 72:1033-1038. [PMID: 36944480 DOI: 10.1136/gutjnl-2023-329639] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emad M El-Omar
- UNSW Microbiome Research Centre, St. George & Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
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14
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Comparison of endoscopic sleeve gastroplasty versus surgical sleeve gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database analysis. Gastrointest Endosc 2023; 97:11-21.e4. [PMID: 35870507 DOI: 10.1016/j.gie.2022.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Endoscopic sleeve gastroplasty (ESG) is an incisionless, transoral, restrictive bariatric procedure designed to imitate sleeve gastrectomy (SG). Comparative studies and large-scale population-based data are limited. Additionally, no studies have examined the impact of race on outcomes after ESG. This study aims to compare short-term outcomes of ESG with SG and evaluate racial effects on short-term outcomes after ESG. METHODS We retrospectively analyzed over 600,000 patients in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2016 to 2020. We compared occurrences of adverse events (AEs), readmissions, reoperations, and reinterventions within 30 days after procedures. Multivariate regression evaluated the impact of patient factors, including race, on AEs. RESULTS A total of 6054 patients underwent ESG and 597,463 underwent SG. AEs were low after both procedures with no significant difference in major AEs (SG vs ESG: 1.1% vs 1.4%; P > .05). However, patients undergoing ESG had more readmissions (3.8% vs 2.6%), reoperations (1.4% vs .8%), and reinterventions (2.8% vs .7%) within 30 days (P < .05). Race was not significantly associated with AEs after ESG, with black race associated with a higher risk of AEs in SG. CONCLUSIONS ESG demonstrates a comparable major AE rate with SG. Race did not impact short-term AEs after ESG. Further prospective studies long-term studies are needed to compare ESG with SG.
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15
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Gala K, Razzak FA, Rapaka B, Abu Dayyeh BK. Novel Endoscopic Bariatric Therapies for the Management of Nonalcoholic Steatohepatitis. Semin Liver Dis 2022; 42:446-454. [PMID: 36116439 DOI: 10.1055/a-1946-6285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Obesity is strongly associated with nonalcoholic fatty liver disease as well as advanced forms of the disease such as nonalcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma. While lifestyle and diet modifications have been the cornerstone of treatment for NASH thus far, they are only effective for less than half of the patients. New endoscopic bariatric therapies (EBTs) have already proved to be safe and effective for the treatment of obesity and type 2 diabetes mellitus, and may provide an intermediate, less invasive, cost-effective option for patients with NASH. In this review, we aim to describe the data and evidence as well as outline future areas of development for endobariatric therapies for the treatment of NASH. In conclusion, EBTs present an effective and safe therapeutic modality for use in the growing pandemic of obesity-related liver disease and should be investigated further with large-scale trials in this patient population.
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Affiliation(s)
- Khushboo Gala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Farah Abdul Razzak
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Babusai Rapaka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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16
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Endobariatrics: well past infancy and maturing rapidly. Curr Opin Gastroenterol 2022; 38:592-599. [PMID: 36219127 DOI: 10.1097/mog.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the key developments with regard to FDA-approved endoscopic bariatric metabolic therapies (EBMTs) in the last 2 years. RECENT FINDINGS The prevalence of obesity has increased during the coronavirus disease 2019 (COVID-19) pandemic, and obesity worsens COVID-19 related outcomes. Several studies have confirmed the safety and short-term efficacy of intragastric balloons (IGBs). In the short-term IGBs may improve steatosis and fibrosis in nonalcoholic fatty liver disease and improve quality of life and mental health. Unfortunately weight loss from these temporarily placed devices is not sustained long-term. Endoscopic sleeve gastroplasty (ESG) may be more effective and durable than IGBs, and result in fewer adverse events compared to bariatric surgery. The recently completed MERIT trial may catapult ESG as a first-line EBMT. Aspiration therapy meets safety and effectiveness thresholds for incorporation into routine practice, but overall acceptance has been lower than other FDA-approved EBMTs. SUMMARY The field of endobariatrics is rapidly maturing. Significant knowledge gaps remain with regards to combining EBMTs with pharmacologic therapy to improve durability of weight loss. The rapid expansion in the literature supporting safety and long-term efficacy ESG may prompt revision of existing guidelines.
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17
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Wei Y, Li P, Zhang S. From surgery to endoscopy: the evolution of the bariatric discipline. Chin Med J (Engl) 2022; 135:2427-2435. [PMID: 36583861 PMCID: PMC9945508 DOI: 10.1097/cm9.0000000000002409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 12/31/2022] Open
Abstract
ABSTRACT Obesity, with its increasing morbidity and prevalence, is now a worldwide public health problem. Obesity and its related comorbidities impose a heavy burden on societal health and the economy. The practice of bariatric surgery has evolved from its early surgical procedures, many of which are no longer routine operations. With clinical practice, research, and experience, bariatric surgery has gradually become an important last resort for the control of weight and obesity-related metabolic diseases in moderately and severely obese patients. However, there is still room for further improvements in bariatric surgical procedures, especially with regard to long-term issues and complications. Endoscopic weight loss technology has developed rapidly in recent years. The advantages of this technology include minimal invasiveness, an obvious weight loss effect, and few complications, thus filling the gap between medications and lifestyle adjustments and surgical treatment of obesity. Endoscopic weight loss technology may even replace surgical bariatric procedures. This review summarized the current status of bariatric metabolic surgery and newly developed bariatric endoscopic procedures.
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Affiliation(s)
- Yongqiu Wei
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050 China
| | - Peng Li
- Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050 China
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18
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Beran A, Matar R, Jaruvongvanich V, Rapaka BB, Alalwan A, Portela R, Ghanem O, Dayyeh BKA. Comparative Effectiveness and Safety Between Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: a Meta-analysis of 6775 Individuals with Obesity. Obes Surg 2022; 32:3504-3512. [PMID: 36053446 DOI: 10.1007/s11695-022-06254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Endoscopic sleeve gastroplasty (ESG) is a novel endoscopic bariatric therapy that complements current medical and surgical therapeutic offerings for weight management and fills an unmet need. Few meta-analyses compared ESG to laparoscopic sleeve gastrectomy (LSG). However, these studies relied on indirect evidence derived from non-comparative studies. Comparative effectiveness data derived from direct comparative studies is needed. We performed a meta-analysis of studies that directly compared ESG with LSG. METHODS A comprehensive search of PubMed, Embase, and Cochrane databases was conducted. Single-arm studies were excluded. Pooled mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CIs) were obtained within a random-effect model. RESULTS Seven studies with 6,775 patients (3,413 with ESG vs. 3,362 with LSG) were included. There were significant differences in 6-month (MD - 7.48; 95% CI - 10.44, - 4.52; P < 0.00001), 12-month (MD - 9.90; 95% CI - 10.59, - 9.22; P < 0.00001), and 24-month (MD - 7.63; 95% CI - 11.31, - 3.94; P < 0.0001) TBWL% favoring LSG over ESG. There was a trend toward lower incidence of adverse events with ESG compared to LSG but did not reach statistical significance (RR 0.51, 95% CI 0.23-1.11, P = 0.09). The incidence of new-onset gastroesophageal reflux disease (GERD) was significantly lower after ESG compared to LSG, 1.3% vs. 17.9%, respectively (RR 0.10, 95% CI 0.02-0.53, P = 0.006). CONCLUSIONS ESG achieved clinically adequate but lower short- and mid-term weight loss when compared to LSG, with fewer adverse events, including GERD. Given the stomach-sparing nature of ESG and acceptable safety profile, it provides an acceptable alternative to LSG for patients with mild-to-moderate obesity.
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Affiliation(s)
- Azizullah Beran
- Divison of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, 46202, USA
| | - Reem Matar
- St George's University of London, London, SW17 0RE, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Veeravich Jaruvongvanich
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Babusai B Rapaka
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Abdullah Alalwan
- Department of Surgery, University of Toledo, Toledo, OH, 43606, USA
| | - Ray Portela
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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19
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Carr P, Keighley T, Petocz P, Blumfield M, Rich GG, Cohen F, Soni A, Maimone IR, Fayet-Moore F, Isenring E, Marshall S. Efficacy and safety of endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy with 12+ months of adjuvant multidisciplinary support. BMC PRIMARY CARE 2022; 23:26. [PMID: 35123409 PMCID: PMC8817771 DOI: 10.1186/s12875-022-01629-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
Background The 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. Methods The 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. Results 16 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. Conclusions In 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 registration This study was registered prospectively at the Australia New Zealand Clinical Trials Registry on 06/03/2018, Registration Number ACTRN12618000337279. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01629-7.
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Affiliation(s)
- Prudence Carr
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Tim Keighley
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Peter Petocz
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Michelle Blumfield
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Graeme G Rich
- Bariatric Gastroenterologist & Director, Bariatrics Australia, Sydney Adventist Hospital, Wahroonga, Australia
| | - Felicity Cohen
- Weightloss Solutions Australia, Varsity Lakes, Queensland, Australia
| | - Asha Soni
- Weightloss Solutions Australia, Varsity Lakes, Queensland, Australia
| | | | - Flavia Fayet-Moore
- Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Skye Marshall
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales. .,Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
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20
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Endoscopic sleeve gastroplasty - minimally invasive treatment for non-alcoholic fatty liver disease and obesity. Indian J Gastroenterol 2021; 40:572-579. [PMID: 34914039 DOI: 10.1007/s12664-021-01202-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adequate weight loss can lead to reduction in steatosis, inflammation, and fibrosis in patients with obesity and non-alcoholic fatty liver disease (NAFLD). We evaluated the role of endoscopic sleeve gastroplasty (ESG) in patients with obesity and NAFLD. METHODS In this single-center prospective study, consecutive adult patients with NAFLD who underwent ESG between November 2018 and May 2019 were included. The primary outcome was the impact of ESG on hepatic parameters: change in alanine aminotransferase (ALT), hepatic steatosis index (HSI), NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) from baseline to 6 and 12 months. Secondary outcomes included change in glycated hemoglobin (HbA1c), percentage weight loss, and safety. Analysis of variance with repeated measures was used for statistical analysis. RESULTS A total of 26 patients (mean age [SD] 41.5 [9.58] years; 16 females) with mean (SD) weight of 99.43 (21.89) kg at baseline were included. There was significant improvement in ALT (mean ± SD) from baseline of 59.54 ± 17.02 IU/L to 49.50 ± 11.72 IU/L and 48.42 ± 13.22 IU/L at 6 and 12 months (p = 0.001). Mean (SD) NFS was significantly improved from 0.228 (1.00) at baseline to -0.202 (1.16) and -0.552 (1.08) at 6 and 12 months (p 0.001). Mean (SD) HSI, FIB-4, and APRI scores significantly reduced from baseline to 6 and 12 months (p = 0.001). There was 18.07% total body weight loss at 12 months, with significant improvement in HbA1c. There were no major adverse events. CONCLUSION ESG is a safe and effective treatment option for patients with NAFLD and obesity causing significant weight loss. Rigorous randomized trials are required to incorporate ESG in NAFLD treatment algorithm.
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21
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Abbasi AB, Cifu AS. The Reversal of a "Reversible" Procedure. Am J Surg 2021; 223:216-217. [PMID: 34412899 DOI: 10.1016/j.amjsurg.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 08/03/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Ali B Abbasi
- University of California at San Francisco, United States.
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22
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Yoon JY, Arau RT. The Efficacy and Safety of Endoscopic Sleeve Gastroplasty as an Alternative to Laparoscopic Sleeve Gastrectomy. Clin Endosc 2021; 54:17-24. [PMID: 33478194 PMCID: PMC7939770 DOI: 10.5946/ce.2021.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/05/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Jin Young Yoon
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Román Turró Arau
- Department of Bariatric Endoscopy, Centro Medico Teknon, Barcelona, Spain
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Goyal H, Kopel J, Perisetti A, Mann R, Ali A, Tharian B, Saligram S, Inamdar S. Endobariatric procedures for obesity: clinical indications and available options. Ther Adv Gastrointest Endosc 2021; 14:2631774520984627. [PMID: 33629061 PMCID: PMC7841245 DOI: 10.1177/2631774520984627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
Obesity remains a growing public health epidemic that has increased healthcare costs and related comorbidities. Current treatment guidelines encourage a multidisciplinary approach starting from patient selection, interventions, and long-term follow-up to maintain weight loss. However, these conservative interventions are largely ineffective at reducing body weight due to low adherence to the treatment regimen. Recently, endoscopic bariatric therapies have become an attractive alternative to traditional invasive bariatric surgeries due to their improved efficacy, safety, and cost-effectiveness. Endoscopic bariatric therapies include intragastric balloon placement, endoscopic sleeve gastroplasty, gastric bypass revision, and aspiration therapy. These procedures fall into two separate categories depending on the primary mechanism involved: restrictive or malabsorptive. Restrictive methods, such as the Orbera® and ReShape™ intragastric balloons, increase satiation and delay gastric emptying while decreasing the amount of food that can be ingested. In contrast, malabsorptive devices, such as the EndoBarrier®, interfere with the small intestine's ability to absorb food while restoring normal gastrointestinal hormone levels regulating satiation. Together, these techniques provide useful alternatives for patients in whom pharmacological or lifestyle modifications have proven ineffective. Despite these advantages, the long-term effects of these procedures on metabolic changes remain to be studied. Furthermore, the management of complications from these procedures continues to evolve. In this review, we aim to elaborate on the clinical indications and efficacy of the endobariatric procedures, together with various types of available endoscopic bariatric therapy procedures.
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Affiliation(s)
- Hemant Goyal
- The Wright Center for Graduate Medical
Education, 501 South Washington Avenue, Scranton, PA 18505, USA
| | - Jonathan Kopel
- Department of Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, USA
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology,
University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rupinder Mann
- Department of Internal Medicine, Saint Agnes
Medical Center, Fresno, CA, USA
| | - Aman Ali
- The Commonwealth Medical College, Wilkes Barre
General Hospital, Wilkes-Barre, PA, USA
| | - Benjamin Tharian
- University of Arkansas for Medical Sciences,
Little Rock, AR, USA
| | - Shreyas Saligram
- Division of Advanced Endoscopy,
Gastroenterology, Hepatology, and Nutrition, Department of Medicine,
University of Texas Health San Antonio, San Antonio, TX, USA
| | - Sumant Inamdar
- University of Arkansas for Medical Sciences,
Little Rock, AR, USA
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