Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients

Published:December 19, 2018DOI:https://doi.org/10.1016/j.gie.2018.12.012

      Background and Aims

      Questions related to the safety and long-term efficacy of endoscopic sleeve gastroplasty (ESG) are not yet answered. Here we report weight loss, morbidity, revisions, and comorbidity resolution during the first 18 months after primary ESG.

      Methods

      This is a consecutive case series from a prospective observational study executed in a specialized center with a standardized pathway for multimodal management of obesity.

      Results

      The 1000 patients in this study had a baseline body mass index of 33.3 ± 4.5 kg/m2 and age of 34.4 ± 9.5 years. Eight hundred ninety-seven patients (89.7%) were women. Mean percentage of total weight loss at 6, 12, and 18 months was 13.7% ± 6.8% (n = 369; follow-up rate = 423; 87.2%), 15.0% ± 7.7% (n = 216; follow-up rate = 232; 93.1%), and 14.8% ± 8.5% (n = 54; follow-up rate = 63; 85.7%), respectively. Lost to follow-up at the 12- and 18-month visits were 6.9% and 14.3%, respectively. Thirteen of 17 cases of diabetes, all 28 cases of hypertension, and 18 of 32 cases of dyslipidemia were in complete remission by the third month. With regard to postoperative complaints, 924 patients (92.4%) complained of nausea or abdominal pain that was controlled with medications during the first week after ESG. Twenty-four patients were readmitted: 8 for severe abdominal pain, of whom 3 had ESG reversal; 7 for postprocedure bleeding, 2 of whom received 2 units of packed red blood cells each; 4 for perigastric collection with pleural effusion, 3 of whom underwent percutaneous drainage; and 5 for postprocedure fever with no sequelae. Eight patients were revised to sleeve gastrectomy, and 5 had redo-ESG. No patient required an emergency intervention, and there were no mortalities.

      Conclusions

      ESG appears to be well tolerated, safe, and effective. Significant weight loss occurs during the first 18 months without mortality or significant morbidity. Some patients require revision or reversal during the first year.

      Graphical abstract

      Abbreviations:

      ED (emergency department), ESG (endoscopic sleeve gastroplasty), %TWL (percentage of total weight lost)
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      Linked Article

      • Endoscopic sleeve gastroplasty for obesity: defining the risk and reward after more than 1600 procedures
        Gastrointestinal EndoscopyVol. 89Issue 6
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          In response to the obesity epidemic, rates of bariatric surgery have increased, particularly laparoscopic sleeve gastrectomy, which is now the most commonly performed bariatric surgery worldwide. Laparoscopic sleeve gastrectomy excises the greater curvature of the stomach, resulting in a restricted tubular reservoir approximately 25% of its native volume. Although technically simple, safe, and effective for weight loss, sleeve gastrectomy is associated with increased health care utilization costs secondary to multiple known serious adverse events (SAEs), and increased prevalence of worsened or de novo GERD with unknown associated long-term risks of Barrett’s esophagus and esophageal adenocarcinoma.
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