In the Journals

Endoscopic sleeve gastroplasty safe, effective for treating obesity

Endoscopic sleeve gastroplasty, a minimally invasive bariatric procedure that reduces the size of the stomach, safely and effectively facilitated weight loss in patients with obesity and improved related comorbidities like high blood pressure, diabetes and fatty liver, according to the results of a prospective study.

“Obesity is a significant health concern that affects millions of people across the country, but until now there hasn’t been an effective minimally invasive treatment we could offer patients,” Reem Z. Sharaiha, MD, MSc, director of bariatric endoscopy and associate director of the Pancreas Program at NewYork-Presbyterian/Weill Cornell Medical Center, and an assistant professor of medicine at Weill Cornell Medicine, said in a press release. “With ESG, we’re giving patients who are eligible for surgery, or deemed to be too high risk for surgery a new option for their care.”

Sharaiha and colleagues from NewYork-Presbyterian — whose physicians have performed the most ESG procedures in the country, per the press release — evaluated data on 91 consecutive patients with clinical obesity who underwent ESG between August 2013 and March 2016 (mean age, 43.86 years; 68% women; mean BMI, 40.7 kg/m2). The study cohort included patients with a BMI greater than 30 kg/m2 for whom noninvasive weight loss measures were insufficient, or a BMI greater than 40 kg/m2 who were not eligible for or refused surgery.

All ESG procedures were performed using the OverStitch system (Apollo Endosurgery), a cap-based flexible endoscopic suturing system.

At 6 months, follow-up data were available for 80% of patients, who lost 14.4% of their total body weight. At 1 year the follow-up rate was 76%, and these patients lost 17.6% of their total body weight. At 2 years, the follow-up rate was 66%, and these patients lost 20.9% of their total body weight.

“The decrease in weight at each time point compared with baseline was statistically significant (all P < .001),” Sharaiha and colleagues wrote.

Additionally, patients showed significant reductions in HbA1c (P = .01), systolic blood pressure (P = .02), waist circumference (P < .001), alanine aminotransferase (P < .001) and serum triglycerides (P = .02) at 1 year follow-up.

However, patients showed no significant changes in LDL after the procedure, and the only serious adverse event was a perigastric leak.

“ESG has evolved into a same day, outpatient endoscopic procedure with a significant impact on weight loss and a low rate of adverse events,” Sharaiha and colleagues concluded. “This study demonstrates that ESG can reduce measures of obesity-associated medical comorbidities in addition to successful weight loss. Although long-term data are still needed, ESG has established its foothold in the armamentarium of bariatric therapy.”

A newly approved randomized controlled trial is currently recruiting patients to compare ESG with diet and exercise, according to the press release. – by Adam Leitenberger

Disclosures: Sharaiha reports she is a consultant for Apollo Endosurgery, and another researcher reports he receives grant support from Mauna Kea Technologist and is a consultant for Boston Scientific.

Endoscopic sleeve gastroplasty, a minimally invasive bariatric procedure that reduces the size of the stomach, safely and effectively facilitated weight loss in patients with obesity and improved related comorbidities like high blood pressure, diabetes and fatty liver, according to the results of a prospective study.

“Obesity is a significant health concern that affects millions of people across the country, but until now there hasn’t been an effective minimally invasive treatment we could offer patients,” Reem Z. Sharaiha, MD, MSc, director of bariatric endoscopy and associate director of the Pancreas Program at NewYork-Presbyterian/Weill Cornell Medical Center, and an assistant professor of medicine at Weill Cornell Medicine, said in a press release. “With ESG, we’re giving patients who are eligible for surgery, or deemed to be too high risk for surgery a new option for their care.”

Sharaiha and colleagues from NewYork-Presbyterian — whose physicians have performed the most ESG procedures in the country, per the press release — evaluated data on 91 consecutive patients with clinical obesity who underwent ESG between August 2013 and March 2016 (mean age, 43.86 years; 68% women; mean BMI, 40.7 kg/m2). The study cohort included patients with a BMI greater than 30 kg/m2 for whom noninvasive weight loss measures were insufficient, or a BMI greater than 40 kg/m2 who were not eligible for or refused surgery.

All ESG procedures were performed using the OverStitch system (Apollo Endosurgery), a cap-based flexible endoscopic suturing system.

At 6 months, follow-up data were available for 80% of patients, who lost 14.4% of their total body weight. At 1 year the follow-up rate was 76%, and these patients lost 17.6% of their total body weight. At 2 years, the follow-up rate was 66%, and these patients lost 20.9% of their total body weight.

“The decrease in weight at each time point compared with baseline was statistically significant (all P < .001),” Sharaiha and colleagues wrote.

Additionally, patients showed significant reductions in HbA1c (P = .01), systolic blood pressure (P = .02), waist circumference (P < .001), alanine aminotransferase (P < .001) and serum triglycerides (P = .02) at 1 year follow-up.

However, patients showed no significant changes in LDL after the procedure, and the only serious adverse event was a perigastric leak.

“ESG has evolved into a same day, outpatient endoscopic procedure with a significant impact on weight loss and a low rate of adverse events,” Sharaiha and colleagues concluded. “This study demonstrates that ESG can reduce measures of obesity-associated medical comorbidities in addition to successful weight loss. Although long-term data are still needed, ESG has established its foothold in the armamentarium of bariatric therapy.”

A newly approved randomized controlled trial is currently recruiting patients to compare ESG with diet and exercise, according to the press release. – by Adam Leitenberger

Disclosures: Sharaiha reports she is a consultant for Apollo Endosurgery, and another researcher reports he receives grant support from Mauna Kea Technologist and is a consultant for Boston Scientific.

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