Endoscopic Sleeve Gastroplasty Likely Safe, Effective For Obesity Over 5 Years

Endoscopic sleeve gastroplasty (ESG) was safe and effective for weight loss, during a single-center 5-year follow-up study.

"It is a great procedure, patients are satisfied, and it achieves good results," Dr. Reem Sharaiha of Weill Cornell Medicine in New York City told Reuters Health by email. "ESG has been gaining momentum among the patient population. Many were interested in the long-term results of endoscopic approaches, including insurances/bariatric surgeons, as most (studies) have not shown durability in the past."

Dr. Sharaiha and colleagues studied 216 patients who underwent ESG at Weill Cornell from 2013-2019 (mean age, 46; 68% women). During the procedure, the endoscopist inserts a suturing device through the mouth and into the stomach, which is sutured to make it smaller.

Study participants had a body mass index of >30 kg/m2 (or >27 with comorbidities) and had failed to achieve a total body weight loss (TBWL) of at least 5% with noninvasive measures such as drugs.

All procedures were performed by the same endoscopist, and patients were followed for up to five years after their procedure.

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As reported in Clinical Gastroenterology and Hepatology, of the 216 participants, one-, three-, and five-year follow-up data were available for 203, 96, and 68 patients, with complete follow-up rates of 70%, 71%, and 82%, respectively.

At one year, the mean TBWL was 15.6%, with 89% and 77% of patients achieving 5% and 10% TBWL, respectively. At three years, the mean TBWL was 14.9%, with 85% and 63% of patients maintaining 5% and 10% TBWL. At five years, the mean TBWL was 15.9% and 90%, with 61% of patients maintaining 5% and 10% TBWL.

Those who failed to achieve 5% weight loss by three months after ESG or experienced weight gain at any point after ESG were offered antiobesity drugs. Fifty-eight patients (27%) started weight-loss pharmacotherapy at a median of five months after ESG due to plateauing of weight loss or weight regain.

Mild adverse events (AEs), including heartburn, nausea and vomiting, were experienced by 32% of patients. Three (1.3%) moderate AEs occurred and there were no severe or fatal AEs.

In multivariable analysis, older age was a predictor of lower TBWL during follow-up, whereas higher TBWL at one month post-ESG and compliance with scheduled visits were predictors of higher TBWL.

Bariatric surgeon Dr. Mir Ali, medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, commented by email to Reuters Health, "The study showed that a number of patients added a weight-loss medication due to the plateauing of the weight loss soon after the procedure, so durability is still a concern," he said. In addition, he noted, "the five-year weight-loss results were not as good as traditional surgical approaches."

Dr. Ali does not perform ESG because the procedure is not covered by insurance and is still considered investigational. "I feel that this procedure, if it becomes widely accepted, may be more appropriate for people who do not meet criteria for weight loss surgery, but have not been successful with diet and exercise alone," he noted. "I hope that there will be continued advances in technology that can make an endoscopic approach to weight loss as a viable alternative to surgery, but we have not reached that point yet."

—Marilynn Larkin

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