Endoscopic sleeve gastroplasty induces, maintains weight loss in mild, moderate obesity

According to a study published in , endoscopic sleeve gastroplasty safely induced and maintained weight loss and ameliorated metabolic complications in patients with class 1 and class 2 obesity. of lancet.

“Endoscopic sleeve gastroplasty (ESG) is a procedure performed through the mouth using an endoscope to reduce the size of the stomach for weight loss and metabolic improvement in diseases such as diabetes.” Barham K. Abu DayeMD, MPH, Helio, director of advanced endoscopy and professor of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, told Helio. “This procedure does not require surgery and preserves the stomach. Unlike surgery, the stomach is not cut or removed. It is a minimally invasive option.

“Hundreds of publications and summaries of ESG experience have been published, but according to joint medical and surgical guidelines dating back to 2011, there remains a need for prospective randomized controlled trials demonstrating efficacy in a controlled group. “There was also a need to better understand the impact of treatment on obesity-related comorbidities.”

In the multicenter ESG Randomized Interventional Trial (MERIT), Abu Dayyeh and colleagues investigated the safety and efficacy of ESG along with lifestyle modification compared to lifestyle modification alone. The primary endpoint was he percentage excess weight loss (EWL) at 52 weeks, and secondary endpoints included change in metabolic comorbidities between groups. Patients in the control group who did not reach his EWL goal of at least 25% weight loss were offered his ESG and after crossover he was followed for an additional 52 weeks. The ESG group patient he was monitored for 104 weeks.

Of the 187 participants included in the modified intention-to-treat analysis, 77 underwent ESG with lifestyle changes and 110 underwent lifestyle changes alone. At week 52, 49.2% of patients in the ESG group and 3.2% of patients in the control group met the primary endpoint, with mean rates of total weight loss of 13.6% and 0.8%, respectively.

A higher proportion of patients in the ESG group, reaching ≥25% of EWL compared to the control group (77% vs. 12%), had at least one improvement in metabolic comorbidity (80% vs. 45%) . However, 12% of patients in the ESG group and 50% of patients in the control group experienced worsening comorbidities.

As is common with conventional bariatric surgery, Abu Dayyeh found that patients with conditions such as diabetes, hypertension, and metabolic syndrome showed clinically meaningful improvements, and that “eating behavior, depression, and quality of life could be improved.” A further improvement in ” was observed.

Of the 60 patients in the ESG group who achieved an EWL of at least 25%, 68% maintained their weight loss at 104 weeks. In addition, patients who crossed over to the ESG group also had improved weight loss curves, with participants reaching an average EWL of 44.1% 52 weeks after crossover. His serious ESG-related adverse events occurred in her three of the 131 participants.

“Studies examining the cost-effectiveness of this endoscopic procedure versus traditional surgical options could have a significant impact on how insurance companies view it as an option for obese patients,” said Abu Dayyeh. I’m here. “Further research should also focus on combination therapy combining pharmacotherapy with ESG to have an even greater impact on weight loss and amelioration of comorbidities.”

He continued, “The ESG has created an opportunity for providers and their patients who are struggling with obesity. There were no or no candidates for it, and now there are procedures that are not only less invasive, but safe, effective and, importantly, organ-sparing.

“As a gastroenterologist and surgeon, I have the opportunity to offer my patients endoscopic surgery that offers significant weight loss and metabolic benefits without requiring permanent removal or alteration of the gastrointestinal tract.”