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Perspectives toward minimizing the adverse events of endoscopic sleeve gastroplasty

      Endoscopic sleeve gastroplasty (ESG) transforms the saccular stomach into a tubular structure along the lesser curvature, thereby reducing gastric functional volume.
      • de Moura D.T.H.
      • de Moura E.G.H.
      • Thompson C.C.
      Endoscopic sleeve gastroplasty: from whence we came and where we are going.
      • Sartoretto A.
      • Sui Z.
      • Hill C.
      • et al.
      Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study.
      • Hill C.
      • El Zein M.
      • Agnihotri A.
      • et al.
      Endoscopic sleeve gastroplasty: the learning curve.
      • Talar Tatarian M.D.
      • Kais A.
      • Rona M.D.
      • et al.
      Evolving procedural options for the treatment of obesity.
      Current medical literature demonstrates that ESG achieves greater than 25% excess weight loss at 12 months with a less than 5% rate of severe adverse events (AEs), which is considered satisfactory according to the Preservation and Incorporation of Valuable endoscopic Innovations document created by a task force assembled by the American Society for Gastrointestinal Endoscopy and the American Society for Metabolic and Bariatric Surgery.
      • Abu Dayyeh B.K.
      • Kumar N.
      • Edmundowicz S.A.
      • et al.
      ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee
      ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies.
      Despite widespread adoption of the procedure,
      • Singh S.
      • Hourneaux de Moura D.T.
      • Khan A.
      • et al.
      Safety and efficacy of endoscopic sleeve gastroplasty worldwide for treatment of obesity: a systematic review and meta-analysis.
      • Hedjoudje A.
      • Abu Dayyeh B.K.
      • Cheskin L.J.
      • et al.
      Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis.
      • de Miranda Neto A.A.
      • de Moura D.T.H.
      • Ribeiro I.B.
      • et al.
      Efficacy and safety of endoscopic sleeve gastroplasty at mid term in the management of overweight and obese patients: a systematic review and meta-analysis.
      no peer-reviewed resource exists to guide the physician on how to optimally perform the procedure. The aim of this article is to help physicians currently performing or those contemplating performing ESG by providing technical insights to facilitate durable tubularization of the stomach while simultaneously minimizing the rate of AEs.

      Abbreviations:

      AE (adverse event), ESG (endoscopic sleeve gastroplasty)
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