Obesity-associated health conditions such as hypertension, type 2 diabetes, high blood pressure, stroke are significant health problems around the world. These health conditions usually affect people that are obese or overweight and their prevalence rates keep increasing.
While there are other weight loss options, Endoscopic Sleeve Gastroplasty (ESG) is a promising alternative procedure for the treatment of obesity. Endoscopic Sleeve Gastroplasty is gaining acceptance worldwide as a non-surgical option for the treatment of obesity.
In this review article, we aimed to study the efficacy and safety of ESG in patients. A single-center retrospective study of obese patients who underwent consecutive ESG was conducted. Data on their weight loss and adverse events at 1, 3, 6, and 12 months were collected and analyzed.
53 patients underwent ESG from March 2017 to October 2018. 81% of the patients were female (43/53). The mean baseline age and BMI were 40.54 ± 13.79 years and 34.78 ± 5.20 kg/m2, respectively. The mean duration of the procedure was 68.96 ± 11.19 minutes. Immediate postoperative complications included mainly epigastric pain (45.2%) and nausea (22.6%) but there was no serious adverse event.
The average %TWL was 8.26%, 11.96%, 14.25%, and 19.94% at 1, 3, 6, and 12 months, respectively. Eighty-eight percent of patients achieved >15%TWL at 12 months. Younger patients (<30 years old) and female patients had greater %TWL at 12 months (p=0.01 and p=0.021, respectively). The last 18 procedures were significantly faster than the first 35 cases (p=0.01).
Conclusion: ESG is effective and safe at promoting weight loss. Younger aged individuals and female gender tend to have better outcomes.
Currently, endoscopic methods and techniques are categorized into six classes which are:
(1) Space-occupying devices such as intragastric balloons
(2) Restrictive procedures such as endoscopic sleeve gastroplasty
(3) Bypass liners
(4) Electrical stimulation
(5) Aspiration therapy
(6) Other therapies such as botulinum toxin A injection or duodenal mucosal resurfacing.
Of all these, restrictive procedures such as endoscopic sleeve gastroplasty have been proven to be the most effective method for weight loss at 12 months.
Endoscopic sleeve gastroplasty is a type of restrictive procedure. It is a novel therapeutic endoscopic technique first introduced by Abu Dayyeh et al. in 2013. It is a minimally invasive technique that reduces the size of the stomach by using an endoscopic suturing device. The sutures constrict and change the structure of the anterior and posterior walls of the stomach, leaving it shaped like a tube. The size of the stomach reduces significantly, restricting the amount of food you can eat.In this review article, we aimed to determine the effectiveness of ESG.
A case-match study conducted by Cheskin et al. directly compared ESG with a combination of low-calorie diet, increased physical activity and behavioral therapy. High-intensity diet and lifestyle therapy (HIDLT) was named as the first-line treatment for obesity.
They examined 105 patients who underwent ESG and 281 patients who underwent HIDLT to compare the efficacy of the two interventions. Patients that underwent ESG had a significantly greater mean percentage of total body weight loss than patients that underwent HIDLT at 3 months. Patients that underwent ESG had a total body weight loss of 14.0% while patients that underwent HIDLT had a total body weight loss of 11.3% at 3 months from the time of their treatment. At 12 months follow-up, patients that underwent ESG had a total body weight loss of 20.6% while patients that underwent HIDLT had a total body weight loss of 14.3%. From these results, ESG is a valuable weight loss alternative for patients with poor compliance with HIDLT.
Given the accumulated knowledge on the effectiveness of ESG in current studies, several systematic reviews and meta-analyses have been published. Five recent systematic reviews and meta-analyses evaluated the effectiveness and safety of ESG for the treatment of obesity.
First, Hedjoudje et al. included 1,772 patients from eight studies published between 2016 and 2019 and reported a 6-month mean of total body weight loss of 15.1%, mean percentage of excess body weight loss of 57.7%, and mean reduction in body mass index (BMI) of 5.65 kg/m2. Weight loss was sustained at 1 year and at 18–24 months with a total body weight loss of 16.5% and 17.2%, respectively.
Second, in a meta-analysis of 2,170 patients from 11 studies published before October 2019, the mean total body weight loss values observed at 6, 12, and 18 months were 15.3%, 16.1%, and 16.8%, respectively. The mean excess body weight loss values observed at 6, 12, and 18 months were 55.8%, 60%, and 73%, respectively.
Third, Li et al. included a total of 1,542 patients from nine studies published up to February 2019 and reported the total body weight loss values of 8.8%, 11.9%, 14.5%, and 16.1%, respectively, at 1, 3, 6, and 12 months. The excess body weight loss values at 1, 3, 6, and 12 months were 31.2%, 43.6%, 53.1%, and 59.1%, respectively.
Fourth, Singh et al. included a total of 1,859 patients from 8 studies published before June 2019, the mean total body weight loss values at 6, 12, and 24 months were 14.9%, 16.4%, and 20.0%, respectively. The mean excess body weight loss values at 6, 12, and 24 months were 55.8%, 61.8%, and 60.4%, respectively.
Fifth, Due-Petersson et al. included a total of 2,142 patients from 23 studies and reported a total body weight loss of 16.3% at 12 months. In addition, ESG led to a significantly greater total body weight loss than intragastric balloon insertion. ESG provided a total body weight loss of 20.6% while intragastric balloon provided a total body weight loss of 13.9%.
The five recent systematic reviews and meta-analyses demonstrated that ESG was effective for weight loss in obese patients than the other weight loss procedures. This finding indicates that ESG reproduces better weight loss outcomes.
Three observational studies and two meta-analyses directly compared the effectiveness of Endoscopic Sleeve Gastroplasty (ESG) and Laparoscopic Sleeve Gastrectomy (LSG). A study by Novikov et al. in 2018 reported that the total body weight loss with LSG was significantly higher at 12 months than with ESG. The total body weight loss with LSG was 29.3% while ESG was 17.6%. This difference remained significant in patients with BMI greater than 40 kg/m2, but not in those with BMI less than 40 kg/m2.
In a case-matched study conducted by Fayad et al. in 2019, there was a significantly greater total body weight loss in patients that underwent ESG than in LSG at the 1-month follow-up. The total body weight loss with ESG was 9.8% while LSG was 6.6%, whereas it was lower in patients that underwent ESG than in patients that underwent LSG at 6 months. At 6 months, the total body weight loss in patients that underwent ESG was 17.1% while the total body weight loss of those that underwent LSG was 23.6%.
Similar to an earlier study, the total body weight loss remained significantly low in patients that underwent ESG with BMI greater than 40 kg/m2, with a borderline significant difference in patients with BMI less than 40 kg/m2.
Both studies showed that weight loss with ESG and LSG was equivalent in patients with BMI less than 40 kg/m2. However, as the BMI increases, bariatric surgical approach is likely to be more effective than endoscopic approach. These findings indicate that the endoscopic approach could be preferentially considered in patients with BMI between 30 and 40 kg/m2. Patients with BMI greater than 40 kg/m2 should be assessed for bariatric surgery.