Background and Aims
Endoscopic sleeve gastroplasty (ESG) is a safe and effective minimally invasive bariatric
procedure. This study compared weight loss in patients undergoing ESG with that of
matched patients undergoing high-intensity diet and lifestyle therapy (HIDLT).
Methods
In this case-matched study, patients were matched 2/3:1 (HIDLT/ESG) by age, sex, and
body mass index (BMI). One hundred five patients (30 men) who underwent ESG + low-intensity
diet and lifestyle therapy (LIDLT) between 2016 and 2018 were compared with 281 patients
(92 men) who underwent HIDLT at the Johns Hopkins Medical Institutions from 2013 to
2014. Weight was evaluated 1, 3, 6, and 12 months after beginning HIDLT or post-ESG
to determine the mean percent total body weight loss (%TBWL).
Results
Mean age across both cohorts was 48.0 ± 12.1, and baseline BMI was 40.0 ± 7.7 kg/m2. In multivariable analysis controlling for age, sex, and baseline BMI, the mean %TBWL
at 1, 3, 6, and 12 months was significantly higher in patients undergoing ESG than
matched patients undergoing HIDLT. Specifically, at 3 months, the mean %TBWL in the
ESG cohort was 14.0% compared with 11.3% in the HIDLT cohort (P <.011), and at 12 months the mean %TBWL in the ESG cohort was 20.6% versus 14.3%
in the HIDLT cohort (P < .001). ESG patients with baseline BMI ≤40 kg/m2 continued to show significantly greater %TBWL than those of the same BMI group in
the HIDLT group at 1, 3, 6, and 12 months after intervention (3 months, coefficient =
3.43 [P < .001]; 12 months, coefficient = 8.14 [P < .001]).
Conclusions
Through 12 months of follow-up, patients who underwent ESG achieved significantly
greater weight loss than patients enrolled in HIDLT. ESG appears to be a valuable
alternative for patients who experience difficulty complying with HIDLT.
Graphical abstract
Graphical Abstract
Abbreviations:
BMI (body mass index), ESG (endoscopic sleeve gastroplasty), HIDLT (high-intensity diet and lifestyle therapy), LIDLT (low-intensity diet and lifestyle therapy), LSG (laparoscopic sleeve gastrectomy), %TBWL (percent total body weight loss)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in obesity among adults in the United States, 2005 to 2014.JAMA. 2016; 315: 2284-2291
- Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 Through 2013-2014.JAMA. 2016; 315: 2292-2299
- Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.JAMA. 2013; 309: 71-82
- Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies.Lancet. 2009; 373: 1083-1096
- Body-mass index and mortality among 1.46 million white adults.N Engl J Med. 2010; 363: 2211-2219
- Obesity and cancer.Exp Clin Endocrinol. 2009; 117: 563-566
- Obesity and its comorbid conditions.Clin Cornerstone. 1999; 2: 17-31
- Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004.J Am Coll Surg. 2008; 207: 928-934
- Obesity and quality of life.Nutrition. 2000; 16: 947-952
- Metabolic/bariatric surgery worldwide 2011.Obes Surg. 2013; 23: 427-436
- Endoscopic sleeve gastroplasty—a new tool to manage obesity.Clin Endosc. 2017; 50: 552-561
- Endoscopic sleeve gastrosplasty for obesity treatment: two years of experience.Braz Arch Dig Surg. 2017; 30: 18-20
- Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up.Obes Surg. 2017; 27: 2649-2655
- Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolics in obese patients.Clin Gastroenterol Hepatol. 2017; 15: 504-510
- Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals.Clin Gastroenterol Hepatol. 2017; 15: 37-43
- Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study.Obes Surg. 2018; 28: 1812-1821
- Endoscopic sleeve gastroplasty: the learning curve.Endosc Int Open. 2017; 5: E900-E904
- Endoscopic sleeve gastroplasty for the treatment of obesity.Endoscopy. 2015; 47: 449-452
- Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population.Endoscopy. 2015; 47: 164-166
- Endoscopic sleeve gastroplasty: how i do it?.Obes Surg. 2015; 25: 1534-1538
- NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults (US).National Institutes of Health. Obes Res. 1998; 6: 51S-209S
- Addressing motivation in globesity treatment: a new challenge for clinical psychology.Front Psychol. 2012; 3: 317
- Stratification by a multivariate confounder score.Am J Epidemiol. 1976; 104: 609-620
- Model-based direct adjustment.J Am Stat Assoc. 1987; 82: 387-394
- A primer on inverse probability of treatment weighting and marginal structural models.Emerg Adulthood. 2016; 4: 40-59
- Constructing a control group using multivariate matched sampling methods that incorporate the propensity score.Am Stat. 1985; 39: 33-38
- Substantial gains in bias reduction from matching with a variable number of controls.Biometrics. 2000; 56: 118-124
- Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study.Gastrointest Endosc. 2019; 89: 782-788
- Endoscopic sleeve gastroplasty versus intragastric balloon insertion: efficacy, durability, and safety.Endoscopy. 2019; 51: 532-539
- Perigastric fluid collection after endoscopic sleeve gastroplasty.Endoscopy. 2016; 48: E340-E341
- A single-operator learning curve analysis for the endoscopic sleeve gastroplasty.Gastrointest Endosc. 2018; 87: 442-447
- Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: how do they compare?.J Gastrointest Surg. 2018; 22: 267-273
- Weight loss intervention adherence and factors promoting adherence: a meta-analysis.Patient Prefer Adherence. 2016; 10: 1547-1559
- Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up.J Am Diet Assoc. 2007; 107: 1755-1767
- The influence of cognitive factors in the treatment of obesity: lessons from the QUOVADIS study.Behav Res Ther. 2014; 63: 157-161
- Weight loss maintenance in relation to locus of control: the MedWeight study.Behav Res Ther. 2015; 71: 40-44
- Temperament and character in obese women with and without binge eating disorder.Compr Psychiatry. 2002; 43: 431-437
- Attachment style contributes to the outcome of a multimodal lifestyle intervention.Biopsychosoc Med. 2012; 6: 3
- Psychology.4th ed. Pearson, Upper Saddle River, NJ2003
- Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes.N Engl J Med. 2017; 376: 641-651
- Consensus Conference Panel. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers.J Am Coll Surg. 2005; 200: 593-604
Article info
Publication history
Published online: September 27, 2019
Accepted:
September 17,
2019
Received:
February 27,
2019
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: S. Kahan: Personal fees from Novo Nordisk, Biologix, and KVK Tech. M. A. Khashab: Consultant for Boston Scientific, Olympus America, and Medtronic; advisory board for Boston Scientific and Olympus; research support from Cook Medical. A. N Kalloo: Founding member, equity holder, and consultant for Apollo Endosurgery. V. Kumbhari: Consultant for Apollo Endosurgery, Boston Scientific, Medtronic, Pentax, and ReShape Life Sciences; research support from Erbe and Apollo Endosurgery. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 436.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
