Suture pattern does not influence outcomes of endoscopic sleeve gastroplasty in obese patients

Abstract Background and study aims ESG is an effective and safe medium-term procedure for obesity treatment. A variety of suture patterns have been reported. We aimed to compare whether there are differences in efficacy depending on suture pattern used. Patients and methods Retrospective and comparative review of 5 years of prospectively collected data, including consecutive obese patients undergoing ESG at two collaborative centers. Primary outcomes included weight loss (mainly % total body weight loss [TBWL] and % exces weight loss [EWL]) at 12 months and safety profile. We compared them according to three suture patterns (transverse bilinear [TBp], longitudinal [Lp] and transverse monolinear [TMp]), and number of sutures (4 – 7) and stitches (< 25, 25 to 30 and > 30) applied. Evolution of major obesity-associated morbidities (hypertension, dyslipidemia, Type 2 diabetes mellitus (T2DM), sleep obstructive apnea syndrome, and arthropathy) were also described. Results 88 patients (mean age 46.1±12.3 years, 69.3 % female) underwent ESG. Mean body mass index (BMI) at baseline was 39.40 ± 4.69 kg/m². At 1 year, %TBWL was 17.36 ± 6.09 % (%EWL 46.41±20.6 %) with TBWL > 10 % in 95.5 % of patients (EWL > 25 % in 94.3 % of patients). According to pattern, there were no differences in %TBWL but there were in %EWL (43.7 ± 20.4 %, 59.8 ± 18.9 % and 45.4 ± 14.9 % in TBp, Lp and TMp patterns, respectively) (P = 0.034). No differences were found related to number of sutures (mean 5.2 ± 0.73, r = 4 – 7) or stitches (mean 27.4 ± 6.50, r = 18 – 50) applied. Forty-three of 72 (59.7 %) major comorbidities were resolved. No serious adverse events were observed with any pattern. Conclusions ESG is an effective procedure at 12-month follow-up for weight loss and comorbidity resolution. All three analyzed patterns are safe and effective without differences in %TBWL, but there was a slight increase in %EWL in Lp, regardless of the number of sutures or stitches applied.

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Endoscopic Sleeve Gastroplasty for Obesity – First Indian Experience: Case Series and Review of Literature

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_51_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 165-167

Author(s):

Nitin Jagtap ◽

Rakesh Kalapala ◽

Abhishek Katakwar ◽

Santosh Darishetty ◽

D Nageshwar Reddy

Keyword(s):

Weight Loss ◽

Adverse Events ◽

Case Series ◽

Body Weight Loss ◽

Total Body Weight ◽

Procedural Time ◽

Sleeve Gastroplasty ◽

Total Body ◽

Total Body Weight Loss

ABSTRACT Introduction: In India, obesity affects >135 million and leads to nearly 5.8 million deaths per year. Some of the unmet need in the management of obesity can be fulfilled by endoscopic therapies such as endoscopic sleeve gastroplasty (ESG). Methods: In this case series, we report our preliminary experience of ESG in three obese patients. We recorded baseline demographic data, total procedural time, adverse events, and percentage total body weight loss (%TBWL) up to 20 weeks. Results: All three patients were male with a median age of 29 years (range 26–39) with a median body mass index of 34.28 kg/m2 (range 32.60–37.13). A total of four full‑thickness and additional three submucosal sutures were applied in each patient. There were no adverse events. The median total procedural time was 105 min (range 90–150). All patients were discharged within 48 h. The median percentage total body weight loss (%TBWL) at 12 weeks was 12.02 (range 10.85–13.33) and at 16 weeks was 14.23 (range 13.84–14.62). The maximum follow‑up so far is 20 weeks (one patient) with %TBWL of 16.38. Conclusion: In our preliminary experience, we conclude that ESG is safe, effective and requires shorter hospital stay. In short‑term follow‑up, there is adequate weight loss without major adverse events.

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Sa1949 A SIMPLE FLUOROSCOPIC SCORE IMMEDIATELY AFTER ENDOSCOPIC SLEEVE GASTROPLASTY PREDICTS TOTAL BODY WEIGHT LOSS

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.1294 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB218-AB219

Author(s):

Kaveh Hajifathalian ◽

Andrea S. Kierans ◽

Shawn L. Shah ◽

Amit Mehta ◽

Angela Wong ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Body Weight Loss ◽

Total Body Weight ◽

Endoscopic Sleeve Gastroplasty ◽

Sleeve Gastroplasty ◽

Total Body ◽

Total Body Weight Loss

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SUN-543 Real World Evidence of Successful Weight Management for the Obese Population: Complete Reversal of Obesity Related Metabolic Co-Morbidities and Weight Loss in Patients Attending a Multidisciplinary Weight Management Clinic in Australia

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1522 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Zoe Rock ◽

Juliana Chen ◽

Joanna Jaques ◽

Bernard L Champion ◽

Reginald V Lord ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Weight Management ◽

Exercise Physiology ◽

Body Weight Loss ◽

Total Body Weight ◽

Management Interventions ◽

Co Morbidity ◽

Total Body ◽

Total Body Weight Loss

Abstract Over 2.5 billion people worldwide are overweight or obese. Multidisciplinary weight management interventions have evolved to address the complexity of weight loss for those with one or more chronic diseases, and the trend of weight regain. The aim of these interventions is to encourage sustainable lifestyle changes, resulting in weight loss and weight maintenance and improvements in comorbidities. While some prospective clinical trials have demonstrated efficacy, results are often not reported by real life practices. The aim of this study was to evaluate the effectiveness of a Sydney based multidisciplinary weight management clinic with endocrinology, dietetics, exercise physiology, psychology, and bariatric surgical domains. All patients who attended the clinic for weight loss purposes between March 2017 and April 2019 were included (n=220). A retrospective chart review was conducted. Patient data on weight, BMI, waist circumference, body composition measurements, and selected blood test results and co-morbidities were analysed. All patient therapy included endocrinological input for co-morbidity identification and management, lifestyle intervention (dietetic and exercise physiology input) with optional adjunct pharmacotherapy or psychological counselling. Of the 220 cohort, 20 of the patients had sleeve gastrectomy. Patient retention in the clinic after the first consultation was 85% (n=186), a high rate within the weight management community. 59% of patients achieved a minimum of 5% total body weight loss, including 18% who achieved greater than 10% total body weight loss. Additionally, 31% of patients lost enough weight to decrease their BMI class by up to 2 or more classes. Of the gastric sleeve cohort average excess body weight loss was 32kg (21-56kg) enhanced by multidisciplinary care in the lead up to surgery. Across the cohort some patients completely reversed co-morbidities; including dyslipidaemia (n=1), hypertension (n=3), NAFLD (n=1), pre-diabetes (n=8) and type 2 diabetes (n=3), OSA (n=1). These results demonstrate that obesity is a chronic condition that can be successfully managed. We have demonstrated significant durable weight loss and improvement in metabolic co-morbidities with holistic coordinated care. Future directions include translating this model of care into standard practice in Australia and other countries where obesity to date not received the same coordinated approach as other chronic conditions.

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Endoscopic gastric reduction with an endoluminal suturing device: a multicenter prospective trial with 1-year follow-up

Endoscopy ◽

10.1055/a-0630-1224 ◽

2018 ◽

Vol 50 (12) ◽

pp. 1156-1162 ◽

Cited By ~ 14

Author(s):

Vincent Huberty ◽

Evzen Machytka ◽

Ivo Boškoski ◽

Marie Barea ◽

Guido Costamagna ◽

...

Keyword(s):

Weight Loss ◽

Behavioral Therapy ◽

Prospective Trial ◽

Body Weight Loss ◽

Total Body Weight ◽

Invasive Technique ◽

Novel Device ◽

Class 1 ◽

Total Body

Abstract Background Obesity is the pandemic disease of this century. Surgery is the only effective treatment but cannot be offered to every patient. Endoscopic sutured gastroplasty is a minimally invasive technique that may potentially fill the gap between surgery and behavioral therapy. In this study, we prospectively investigated the efficacy and safety of a novel suturing device. Methods After a pre-bariatric multidisciplinary work-up, class 1 and 2 obese patients were included. Using a simple triangulation platform, transmural sutures with serosa-to-serosa apposition were performed in the gastric cavity. Patients were followed according to the same routines as those performed for bariatric procedures. Results Between November 2015 and December 2016, 51 patients were included across three European Centers. Mean body mass index at baseline was 35.1 kg/m2 (SD 3.0). Excess weight loss and total body weight loss at 1 year were 29 % (SD 28) and 7.4 % (SD 7), respectively, for the whole cohort (45 patients). At follow-up gastroscopy, 88 % of sutures were still in place (30 patients). No severe adverse events were observed. Conclusions Endoscopic sutured gastroplasty using this novel device is safe and achieved weight loss results in line with criteria expected for these endoluminal techniques. Further prospective studies vs. placebo or nutritional support are needed.

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Endoscopic sleeve gastroplasty: a modified technique with greater curvature compression sutures

Endoscopy International Open ◽

10.1055/a-0996-8089 ◽

2019 ◽

Vol 07 (10) ◽

pp. E1303-E1309 ◽

Cited By ~ 3

Author(s):

Michael A. Glaysher ◽

Alma L. Moekotte ◽

Jamie Kelly

Keyword(s):

Weight Loss ◽

Body Weight ◽

Effective Means ◽

Body Weight Loss ◽

Total Body Weight ◽

Modified Technique ◽

Longitudinal Compression ◽

Median Baseline ◽

Endoscopic Sleeve Gastroplasty ◽

Sleeve Gastroplasty

Abstract Background Endoscopic sleeve gastroplasty (ESG) is rapidly becoming established as a safe and effective means of achieving substantial weight loss via the transoral route. New ESG suture patterns are emerging. Our aim was to investigate whether superior weight loss outcomes can be achieved by using a unique combination of longitudinal compression sutures and “U”-shaped sutures. Methods This is a retrospective review of prospectively collected data of all patients undergoing ESG by a single operator in a single UK center. Results Between January 2016 and December 2017, 32 patients (23 female) underwent ESG; n = 9 cases were completed utilizing a commonly used triangular suture pattern (“no longitudinal compression”) and n = 23 cases were completed using our unique “longitudinal compression” suture pattern. In the no compression and compression groups, the mean ages were 45 ± 12 years and 43 ± 10 years, the median baseline weights were 113.6 kg (range 82.0 – 156.4) and 107 kg (range 74.0 – 136.0), and the median baseline body mass indexes (BMIs) were 35.9 kg/m2 (range 30.9 – 43.8) and 36.5 kg/m2 (range 29.8 – 42.9), respectively. After 6 months, body weight had decreased by 21.1 kg (range, 12.2 – 34.0) in the compression group (n = 7) versus 10.8 kg (range, 7.0 – 25.8) in the no compression group (n = 5) (P = 0.042). Correspondingly, BMI decreased by 7.8 kg/m2 (range, 4.9 – 11.2) and 4.1 kg/m2 (range, 2.6 – 7.2) in each group, respectively (P = 0.019). Total body weight loss (%TBWL) was greater in the compression group at 19.5 % (range, 12.9 – 30.4 %) compared to 13.2 % (range, 6.2 – 17.1 %) in the non-compression group (P = 0.042). No significant adverse events were reported in this series. Conclusion The technique of ESG is evolving and outcomes from endoscopic bariatric therapies continue to improve. We provide preliminary evidence of superior weight loss achieved through a modified gastroplasty suture pattern.

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Initial experience with endoscopic sleeve gastroplasty in Poland

Polish Journal of Surgery ◽

10.5604/01.3001.0011.7488 ◽

2018 ◽

Vol 90 (2) ◽

pp. 16-22 ◽

Cited By ~ 1

Author(s):

Aleksander Sowier ◽

Przemysław Pyda ◽

Anna-Maria Borucka ◽

Sebastian Sowier ◽

Jacek Białecki ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Body Weight Loss ◽

Total Body Weight ◽

Sleeve Resection ◽

Less Invasive ◽

Endoscopic Sleeve Gastroplasty ◽

Sleeve Gastroplasty

Introduction: Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. Materials and methods: Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. Results: The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. Conclusions: Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. Discussion: Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up.

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Loss of lean body mass within one week as a major determinant for total weight loss at one month after gastrectomy for gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.219 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 219-219

Author(s):

Toru Aoyama ◽

Takaki Yoshikawa ◽

Taiichi Kawabe ◽

Hirohito Fujikawa ◽

Tsutomu Hayashi ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Lean Body Mass ◽

Body Mass ◽

Early Period ◽

Body Weight Loss ◽

Total Body Weight ◽

Late Period ◽

Total Body ◽

Total Body Weight Loss

219 Background: Postoperative changes in body weight and composition during first 1 month after gastrectomy remained unclear. Methods: The patients who underwent gastrectomy for gastric cancer between May 2010 and October 2013 were examined. Body weight and composition were evaluated by bioelectrical impedance analyzer within 1 week before surgery (first measurement), at 1 week after surgery (second measurement), and at 1 month after surgery (third measurement). The changes of the early period were defined as the differences until the second measurement, while those of the late period as the differences from the second to the third measurement. Results: Two-hundred forty four patients were selected for this study. Total body weight loss (BWL) within 1 month was -3.4 kg and the rate of body weight at 1 month to the preoperative body weight was 94.1%. BWL was significantly greater in the early period rather than that of the late period (-2.1 kg vs -1.2 kg, p<0.001). In the early period, loss of lean body mass was significantly greater than loss of fat mass (-1.5 kg vs -0.6 kg, p<0.001). The same trend was observed regardless of type of gastrectomy and surgical approach. Conclusions: Loss of lean body mass within 1 week was a major determinant for total body weight loss at 1 month. To maintain lean body mass within 1 week and total body weight at 1 month, future trial should be focused on not the surgical approach but nutritional intervention within 1 week.

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Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study

Children ◽

10.3390/children5090116 ◽

2018 ◽

Vol 5 (9) ◽

pp. 116 ◽

Cited By ~ 10

Author(s):

Alexander Toth ◽

Gricelda Gomez ◽

Alpana Shukla ◽

Janey Pratt ◽

Hellas Cena ◽

...

Keyword(s):

Weight Loss ◽

Young Adults ◽

Body Weight ◽

Weight Change ◽

Weight Regain ◽

Body Weight Loss ◽

Total Body Weight ◽

Percent Weight Loss ◽

Total Body ◽

Weight Loss Medications

This paper presents a retrospective cohort study of weight loss medications in young adults aged 21 to 30 following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between November 2000 and June 2014. Data were collected from patients who used topiramate, phentermine, and/or metformin postoperatively. Percentage of patients achieving ≥5%, ≥10%, or ≥15% weight loss on medications was determined and percent weight change on each medication was compared to percent weight change of the rest of the cohort. Our results showed that 54.1% of study patients lost ≥5% of their postsurgical weight; 34.3% and 22.9% lost ≥10% and ≥15%, respectively. RYGB had higher median percent weight loss (−8.1%) than SG (−3.3%) (p = 0.0515). No difference was found in median percent weight loss with medications started at weight plateau (−6.0%) versus after weight regain (−5.4%) (p = 0.5304). Patients taking medications at weight loss plateau lost 41.2% of total body weight from before surgery versus 27.1% after weight regain (p = 0.076). Median percent weight change on metformin was −2.9% compared to the rest of the cohort at −7.7% (p = 0.0241). No difference from the rest of the cohort was found for phentermine (p = 0.2018) or topiramate (p = 0.3187). Topiramate, phentermine, and metformin are promising weight loss medications for 21 to 30 year olds. RYGB patients achieve more weight loss on medications but both RYGB and SG benefit. Median total body weight loss from pre-surgical weight may be higher in patients that start medication at postsurgical nadir weight. Participants on metformin lost significantly smaller percentages of weight on medications, which could be the result of underlying medical conditions.

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Redo endoscopic sleeve gastroplasty: technical aspects and short-term outcomes

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819896179 ◽

2020 ◽

Vol 13 ◽

pp. 175628481989617 ◽

Cited By ~ 2

Author(s):

Ivo Boškoski ◽

Valerio Pontecorvi ◽

Camilla Gallo ◽

Vincenzo Bove ◽

Lucrezia Laterza ◽

...

Keyword(s):

Weight Loss ◽

Case Series ◽

Body Weight Loss ◽

Total Body Weight ◽

Baseline Body Mass Index ◽

Short Term ◽

Technical Aspects ◽

Endoscopic Sleeve Gastroplasty ◽

Sleeve Gastroplasty

Background: Endoscopic sleeve gastroplasty (ESG) is a restrictive endoscopic bariatric procedure providing promising results. In this short case series, we analyze the technical aspects and short-term outcomes of the redo ESG. Methods: A retrospective analysis was done on a prospective database of all patients that were selected by a multidisciplinary team that underwent ESG between March 2017 and May 2019. Patients that underwent a redo ESG because of a progressive loss of satiety, weight regain, or insufficient weight loss due to high baseline body mass index were included. Percentage of excess weight loss (%EWL), percentage of total body weight loss (%TBWL), and the Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire were evaluated during follow-up. Results: A total of 120 ESG procedures were performed with mean %EWL of 44.4% (± 19.5), mean %TBWL of 18.3% (± 6.7), and mean BAROS of 4.5 (± 1.7) at 12 months. Of those, four patients that underwent a redo ESG were identified. A total of three of them had a redo ESG after 12 months from the first ESG, whereas one of them had a redo ESG after 7 months. During the second procedure, old threads were removed with scissors and new stitches were positioned following a triangular pattern and avoiding overlap with the previous stitches. No adverse events were reported during the redo ESG. Six month follow-up was available for three patients, mean %EWL and %TBWL were 44.2% and 20.4%, respectively; BAROS questionnaire mean score was 6.3. One patient had only 1 month follow-up with a mean %EWL and %TBWL of 33.3% and 12.2%, respectively; BAROS questionnaire reported score was 6. All included patients reported excellent satiety feeling after redo ESG. Conclusions: The redo ESG short-term outcomes are completely satisfying in terms of safety and efficacy. The need to perform a redo ESG should not be considered as a failure of the previous procedure, but it can be considered as a second step of the endoscopic treatment strategy.

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