Comparison of distal primary obesity surgery endolumenal techniques for the treatment of obesity (with videos)

  • Pichamol Jirapinyo
    Affiliations
    Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Harvard Medical School, Boston, Massachusetts, USA
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  • Christopher C. Thompson
    Correspondence
    Reprint requests: Christopher C. Thompson, MD, MSc, Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, 75 Francis St, Boston, MA 02115.
    Affiliations
    Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author

      Background and Aims

      Distal primary obesity surgery endolumenal (POSE) procedures involve plication of the gastric body, sparing the fundus. We aim to assess the efficacy of distal POSE procedures and to compare plication techniques (single-helix vs double-helix approaches).

      Methods

      This is a prospective registry study of patients who underwent distal POSE procedures using 2 techniques: the single-helix plication technique, in which a single plication with serosa-to-serosa approximation is obtained with each device activation, and the double-helix plication technique, where 2 serosa-to-serosa plications with an internal mucosa-to-mucosa approximation are obtained with each device activation.

      Results

      One hundred ten patients (90 women; mean age, 43 ± 13 years) underwent distal POSE procedures. Baseline body mass index was 38.2 ± 6.1 kg/m2. Technical success was 100%. An average of 21 ± 5 plications were placed per case. The gastric body was shortened by 74%. At 12 months, patients experienced 15.8% ± 8.9% total weight loss (TWL) (P < .0001), with 93% and 61% achieving at least 5% and 10% TWL, respectively. Blood pressure, insulin resistance, and liver enzymes improved. The serious adverse event rate was .9%, including a case of gastric perforation. Of 110 patients, 42 and 68 underwent distal POSE procedures using a single- or double-helix technique, respectively. The double-helix technique resulted in greater reduction in gastric volume (length reduction by 78% vs 65%, P < .0001), weight loss (20.3% ± 8.3% vs 13.4% ± 8.3% TWL, P = .005), and proportion of patients achieving 10% TWL (94.7% vs 58.3%, P = .03) than the single-helix technique.

      Conclusions

      Distal POSE techniques appear to be effective at treating obesity and its related comorbidities. The double-helix technique is associated with greater gastric volume reduction, weight loss, and response rate.

      Graphical abstract

      Abbreviations:

      AE (adverse event), BMI (body mass index), ESG (endoscopic sleeve gastroplasty), POSE (primary obesity surgery endolumenal), TWL (total weight loss)
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