Meeting NewsPerspective

Various bariatric endoscopy techniques comparably effective

WASHINGTON — A comparison of four different bariatric endoscopy techniques showed comparable weight loss through one year, according to a presenter here.

Gontrand Lopez-Nava, MD, and colleagues from Hospital Madrid Sanchinarro in Spain, concluded that the Orbera intragastric balloon (Apollo Endosurgery), the Reshape Duo intragastric balloon (Reshape Medical), endoscopic sleeve gastroplasty (Apollo procedure) and the Primary Obesity Surgery Endolumenal (POSE; USGI Medical) procedure are all effective for treating patients with obesity when administered by a multidisciplinary care team.

“Many different bariatric endoscopy techniques have shown effectiveness and safety, but most of the centers tend to specialize in one particular procedure, so it’s difficult to establish differences between techniques without bias in follow-up or the endoscopist’s skills,” Lopez-Nava said during his presentation. “No comparative studies of different techniques have been published.”

Lopez-Nava and colleagues conducted a prospective study comparing one-year outcomes of these four techniques performed in more than 1,000 patients by the same endoscopist (70% women, mean BMI, 38 kg/m2, mean age, 44.6 years). Overall, 394 were treated with the Orbera balloon, 92 with the Duo balloon, 299 with endoscopic sleeve gastroplasty, and 234 with the POSE endoscopic plication procedure.

A total of 400 (40.1%) properly completed one-year follow-up. The proportion of patients who achieved between 10% and 20% total body weight loss with endoscopic sleeve gastroplasty was 17.5% (95% CI, 81.1-36.1) compared with 16.1% (95% CI, 74.4-34.4) with the Orbera balloon, 15.3% (95% CI, 75.4-24.5) with the Duo balloon and 15.3% (95% CI, 72.3-26.6) with the POSE procedure.

Response defined by ASGE criteria of more than 10% total body weight loss was achieved by 74% of Orbera patients, 75% of Duo patients, 81% of endoscopic sleeve gastroplasty patients and 72% of POSE patients.

Notably, patients who had more nutritional contacts and more frequent attendance to scheduled visits showed significantly higher total body weight loss (P < .05).

“There was no statistically significant difference between the four techniques,” Lopez-Nava said.

He concluded that these four techniques are comparable within a multidisciplinary approach, and that “avoiding loss of follow-up” should be prioritized to improve outcomes. – by Adam Leitenberger

 

Reference:

Lopez-Nava G, et al. Abstract 71. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

 

Disclosures: Lopez-Nava reports consulting for USGI and Apollo. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

WASHINGTON — A comparison of four different bariatric endoscopy techniques showed comparable weight loss through one year, according to a presenter here.

Gontrand Lopez-Nava, MD, and colleagues from Hospital Madrid Sanchinarro in Spain, concluded that the Orbera intragastric balloon (Apollo Endosurgery), the Reshape Duo intragastric balloon (Reshape Medical), endoscopic sleeve gastroplasty (Apollo procedure) and the Primary Obesity Surgery Endolumenal (POSE; USGI Medical) procedure are all effective for treating patients with obesity when administered by a multidisciplinary care team.

“Many different bariatric endoscopy techniques have shown effectiveness and safety, but most of the centers tend to specialize in one particular procedure, so it’s difficult to establish differences between techniques without bias in follow-up or the endoscopist’s skills,” Lopez-Nava said during his presentation. “No comparative studies of different techniques have been published.”

Lopez-Nava and colleagues conducted a prospective study comparing one-year outcomes of these four techniques performed in more than 1,000 patients by the same endoscopist (70% women, mean BMI, 38 kg/m2, mean age, 44.6 years). Overall, 394 were treated with the Orbera balloon, 92 with the Duo balloon, 299 with endoscopic sleeve gastroplasty, and 234 with the POSE endoscopic plication procedure.

A total of 400 (40.1%) properly completed one-year follow-up. The proportion of patients who achieved between 10% and 20% total body weight loss with endoscopic sleeve gastroplasty was 17.5% (95% CI, 81.1-36.1) compared with 16.1% (95% CI, 74.4-34.4) with the Orbera balloon, 15.3% (95% CI, 75.4-24.5) with the Duo balloon and 15.3% (95% CI, 72.3-26.6) with the POSE procedure.

Response defined by ASGE criteria of more than 10% total body weight loss was achieved by 74% of Orbera patients, 75% of Duo patients, 81% of endoscopic sleeve gastroplasty patients and 72% of POSE patients.

Notably, patients who had more nutritional contacts and more frequent attendance to scheduled visits showed significantly higher total body weight loss (P < .05).

“There was no statistically significant difference between the four techniques,” Lopez-Nava said.

He concluded that these four techniques are comparable within a multidisciplinary approach, and that “avoiding loss of follow-up” should be prioritized to improve outcomes. – by Adam Leitenberger

 

Reference:

Lopez-Nava G, et al. Abstract 71. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

 

Disclosures: Lopez-Nava reports consulting for USGI and Apollo. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

    Perspective
    John R. Saltzman

    John R. Saltzman

    There are an increasing number of endoscopic therapies for treatment of obesity and it can be confusing to know which are appropriate as well as which are most effective. This type of comparative study across multiple endoscopic bariatric therapies has not been previously reported to my knowledge. The results show – at least in these expert hands – essentially equivalent outcomes for two different balloons, endoscopic sleeve gastrectomy and the POSE procedure.

    We do not know how patients were selected for one procedure over another. It may be that early treatments were done with one therapy and more complicated were treated with another, and thus there may be selection bias. This is also an expert, high-volume center performing all these procedures. Thus, these results may not be entirely generalizable to all endoscopists.

    This study emphasizes the importance of ongoing multidisciplinary care and not just performing the procedures. These researchers show that patients who continued to visit a nutritionist or dietitian have better outcomes. This multidisciplinary approach is key to good outcomes.

    Overall, this gives hope to endoscopists who are new to the field of bariatric endoscopy that the currently available endoscopic bariatric therapies may all be effective.

    • John R. Saltzman, MD, FACP, FACG, FASGE, AGAF
    • Brigham and Women’s Hospital Boston, Mass.

    Disclosures: Saltzman reports no relevant financial disclosures.

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