Endoscopic sleeve gastroplasty: suturing the gastric fundus does not confer benefit

Endoscopy ◽  
2020 ◽  
Author(s):  
Jad Farha ◽  
Christopher McGowan ◽  
Abdellah Hedjoudje ◽  
Mohamad I. Itani ◽  
Shahem Abbarh ◽  
...  
Keyword(s):  
Weight Loss ◽  
Primary Outcome ◽  
Gastric Fundus ◽  
Serious Adverse Event ◽  
Endoscopic Sleeve Gastroplasty ◽  
Significant Difference ◽  
Sleeve Gastroplasty ◽  
The Mean ◽  
Procedure Duration ◽  
Percentage Excess Weight Loss

Abstract Background There is heterogeneity regarding the technical aspects of endoscopic sleeve gastroplasty (ESG), such as applying fundal sutures. Our aim was to determine whether ESG with fundal suturing (ESG-FS) affects weight loss and the serious adverse event (SAE) rate when compared with ESG with no fundal suturing (ESG-NFS). Methods We conducted a two-center retrospective analysis of 247 patients who underwent ESG with or without fundal suturing. The primary outcome was percentage excess weight loss (%EWL) at 3, 6, and 12 months post-ESG. The secondary outcomes included the SAE rate and procedure duration. Results At 3, 6, and 12-months, ESG-NFS had a significantly greater mean %EWL compared with ESG-FS (38.4 % [standard deviation (SD) 15.3 %] vs. 31.2 % [SD 13.9 %], P = 0.001; 54.7 % [SD 19.2 %] vs. 37.7 % [SD 17.3 %], P < 0.001; 65.3 % [SD 21.1 %] vs. 40.6 % [SD 23.5 %], P < 0.001, respectively). There was no statistically significant difference in the SAE rates for ESG-NFS (n = 2; 2.0 %) and ESG-FS (n = 4; 2.6 %; P > 0.99). The mean procedure time was significantly shorter in the ESG-NFS group at 59.1 minutes (SD 32.7) vs. 93.0 minutes (35.5; P < 0.001), and a lower mean number of sutures were used, with 5.7 (SD 1.1) vs. 8.4 (SD 1.6; P < 0.001). Conclusion ESG-NFS demonstrated greater efficacy and shorter procedure duration. Therefore, fundal suturing should not be performed.

SHORT-TERM WEIGHT LOSS OF THE ENDOSCOPIC SLEEVE GASTROPLASTY FOR PRIMARY OBESITY

2020 ◽  
Author(s):  
AJ del Pozo-Garcia ◽  
DR de la Cruz ◽  
T Valdés-Lacasa ◽  
S Nevado ◽  
R Polanco ◽  
...  
Keyword(s):  
Weight Loss ◽  
Short Term ◽  
Endoscopic Sleeve Gastroplasty ◽  
Sleeve Gastroplasty

scholarly journals Tu1908 – Efficacy of Pharmacotherapy in the Treatment of Weight Regain and Inadequate Weight Loss Following Endoscopic Sleeve Gastroplasty

2019 ◽  
Vol 156 (6) ◽  
pp. S-1168-S-1169 ◽  
Author(s):  
Kaveh Hajifathalian ◽  
Amit Mehta ◽  
Shawn L. Shah ◽  
Danny Issa ◽  
Qais M. Dawod ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Regain ◽  
Endoscopic Sleeve Gastroplasty ◽  
Sleeve Gastroplasty ◽  
Inadequate Weight Loss

scholarly journals Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?

Endoscopy ◽  
2020 ◽  
Author(s):  
Gontrand Lopez-Nava ◽  
Ravishankar Asokkumar ◽  
Inmaculada Bautista-Castaño ◽  
Janese Laster ◽  
Anuradha Negi ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Repeated Measures ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Effective Treatment Option ◽  
Endoscopic Sleeve Gastroplasty ◽  
Sleeve Gastroplasty ◽  
Laparoscopic Greater Curve Plication

Abstract Background Endoscopic sleeve gastroplasty (ESG) is an effective treatment option for obesity. However, data comparing its efficacy to bariatric surgery are scarce. We aimed to compare the effectiveness and safety of ESG with laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curve plication (LGCP) at 2 years. Methods We reviewed 353 patient records and identified 296 patients who underwent ESG (n = 199), LSG (n = 61), and LGCP (n = 36) at four centers in Spain between 2014 and 2016. We compared their total body weight loss (%TBWL) and safety over 2 years. A linear mixed model (LMM) was used to analyze repeated measures of weight loss outcomes at 6, 12, 18, and 24 months to compare the three procedures. Results Among the 296 patients, 210 (ESG 135, LSG 43, LGCP 32) completed 1 year of follow-up and 102 (ESG 46, LSG 34, LGCP 22) reached 2 years. Their mean (standard deviation [SD]) body mass index (BMI) was 39.6 (4.8) kg/m2. There were no differences in age, sex, or BMI between the groups. In LMM analysis, adjusting for age, sex, and initial BMI, we found ESG had a significantly lower TBWL, %TBWL, and BMI decline compared with LSG and LGCP at all time points (P = 0.001). The adjusted mean %TBWL at 2 years for ESG, LSG, and LGCP were 18.5 %, 28.3 %, and 26.9 %, respectively. However, ESG, when compared with LSG and LGCP, had a shorter inpatient stay (1 vs. 3 vs. 3 days; P < 0.001) and lower complication rate (0.5 % vs. 4.9 % vs. 8.3 %; P = 0.006). Conclusion All three procedures induced significant weight loss in obese patients. Although the weight loss was lower with ESG compared with other techniques, it displayed a better safety profile and shorter hospital stay.

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

2019 ◽  
Vol 07 (10) ◽  
pp. E1303-E1309 ◽  
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.

scholarly journals PSU21 COST-EFFECTIVENESS OF ENDOSCOPIC SLEEVE GASTROPLASTY FOR WEIGHT LOSS

2019 ◽  
Vol 22 ◽  
pp. S895-S896
Author(s):  
E. Paw ◽  
C. Schilling ◽  
M. Gradel ◽  
J. Ballreich ◽  
E.F. Drabo
Keyword(s):  
Weight Loss ◽  
Cost Effectiveness ◽  
Endoscopic Sleeve Gastroplasty ◽  
Sleeve Gastroplasty

Initial experience with endoscopic sleeve gastroplasty in Poland

2018 ◽  
Vol 90 (2) ◽  
pp. 16-22 ◽  
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.

scholarly journals Endoscopic Sleeve Gastrectomy Conversion to Roux-en-Y Gastric Bypass

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Sorin Cimpean ◽  
Marechal Marie-Therese ◽  
Benjamin Cadiere ◽  
Guy-Bernard Cadiere
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Gastric Motility ◽  
Gastric Volume ◽  
Endoscopic Suturing ◽  
Endoscopic Sleeve Gastroplasty ◽  
Insufficient Weight Loss ◽  
Sleeve Gastroplasty ◽  
Greater Curvature

Endoscopic Sleeve Gastroplasty (ESG) is a restrictive endoscopic bariatric procedure that provides a reduction of the gastric volume and an alteration of the gastric motility. The volume of the stomach is reduced by approximately 70% through plication of the greater curvature of the stomach using an endoscopic suturing device. In case of failure, the surgical conversion is possible. We present a case of a patient with previous ESG with insufficient weight loss and gastro-oesophageal reflux. We performed a conversion to Roux-en-Y Gastric Bypass with satisfactory results.

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

2020 ◽  
Vol 13 ◽  
pp. 175628481989617 ◽  
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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