Endoscopic techniques offer more options for obesity management
MAUI, Hawaii — Endoscopic management has a clear role in the future of obesity care, with multiple options available for patients, according to an expert at the GUILD Conference 2020.
Christopher Thompson, MD, MSc, director of endoscopy at Brigham and Women’s Hospital, said that while the epidemic of obesity becoming a greater and greater problem, effective interventions of the disease are still somewhat lacking.
“There are 19 million people with a BMI over 35 [in the United States],” he said in his presentation. “Other than the 1% that get surgery, the rest are really struggling without a lot of options.”
While diet and exercise are important to any weight loss strategy, Thompson said they only account for a very small percentage of total body weight lost and do not do much to really address some of the comorbidities associated with obesity. Additionally, most patients have difficulty maintaining their new, lower weight.
“The problem is the set-point theory,” Thompson said. “Their resting metabolic rate [diminished] substantially. If you just diet and exercise, your body thinks it’s supposed to be heavier. So, it’s going to slow its burn down, so you gain weight back.”
Endoscopic techniques, as well as surgery, can help reset that rate, helping patients to keep weight off after losing it.
Thompson discussed several endoscopic techniques that help patients control their weight or improve metabolic comorbidities.
These devices include things like balloons, the transpyloric shuttle and Gelesis 100, a superabsorbent gel that takes up space in the stomach.
Studies have shown that balloons can help patients lose approximately 25% of excess weight and achieve more than 11% total body weight loss at 12 months while improving waist circumference, blood glucose and hypertension. Thompson said patients experience increased gastric retention while the balloons are in place, giving a clue about their mechanisms of action.
In a sham-controlled study comprising 270 patients, the transpyloric shuttle helped patients achieve 9.5% total weight loss at one year compared with 2.8% with placebo. More than 60% of patients had more than 5% total weight lost and 40% had more than 10% total weight lost.
Thompson said a technique known as trans-oral outlet reduction (TORe) helped produce 7.5%. 7% and 6.1% total body weight loss at year 1, 3 and 5 respectively. It also helped produce up to 10 kg in absolute weight loss at 5 years.
Another technique, suturing endoscopic sleeve gastrectomy, helped patients achieve 20.9% total weight loss at 24 months with a serious adverse event rate of 1.1%.
In aspiration therapy, patients receive an outlet from the stomach to the skin through which they can release excess calories after eating. In the Pathway Trial, patients who used the AspireAssist device had a percentage of excess weight loss great than 30% compared with 10% in the control group. The device also met the co-primary endpoint of at 50% of patients in the study achieving at least 25% excess weight loss at 52 weeks.
“Endoscopic bariatric metabolic therapies are effective and have an important role in the treatment of obesity,” Thompson said. “Strong after care is critical to optimizing outcomes, and you have to participate in a multidisciplinary center, and combination therapies and personalized treatment programs are the keys to future success.” – by Alex Young
Thompson C. Endoscopic Therapy of Obesity. Presented at: GUILD Conference 2020; February 16-19, 2020; Maui, Hawaii.
Disclosure: Thompson reports financial ties to Apollo Endosurgery, Aspire Bariatrics, Boston Scientific, EndoTAGSS, Fractyl, GI Dynamics, GI Windows, Medtronic, Olympus, Spatz and USGI Medical.