Endoscopic Sleeve Gastroplasty 5-Year Outcomes

Reem Sharaiha, MD, MSc

A recent study, presented at Digestive Disease Week 2019 in San Diego, CA, found that endoscopic sleeve gastroplasty (ESG) was associated with significant and sustained weight loss in the first study of ESG outcomes over a 5-year period.

"We found very sustainable, significant weight loss for over 200 patients between the 1- and 5-year mark, losing an average of up to 15 to 20 percent of total body weight," said principal investigator Reem Sharaiha, MD, MSc, Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY.

Sharaiha described ESG in the statement as a relatively new, minimally invasive, out-patient weight loss procedure involving "a series of sutures, cinching the stomach like an accordion, down to the size of a banana."

In an interview with MD Magazine^® Sharaiha considered the differences between ESG and current endobariatric procedures.

"ESG seems to have better sustained immediate adverse events, including less severe nausea and pain compared to other procedures," she said. "ESG only requires 1 endoscopy, whereas intragastric balloon insertion currently requires 2 endoscopies or at least insertion and removal of the balloons and AspireAssist requires multiple visits to ensure the device is working properly."

Sharaiha and colleagues conducted a retrospective review of prospectively collected data on 203 patients undergoing ESG between August 2013 and October 2018. Baseline BMI was 39±7kg/m² and the study’s primary outcome was body weight loss and percentage total body weight loss (TBWL). Significant weight loss was defined as 10% or more TBWL.

The investigators reported average weight loss of 18.1kg (95% CI, 15.8-20.5) as 15.2% (95% CI, 13.5-16.8) TBWL at 1 year, with a 73% follow-up rate. Investigators found that average weight loss at 2 years was 17.3kg with 14.5% TBWL. At 3 years, weight loss was 20.8kg with 15.7% TBWL, with 64% follow-up. Lastly, investigators noted that weight loss at 5 years, with 89% follow-up, was 18.7kg with 14.5% TBWL.

At 12, 24, 36 and 60 months, the percentage of patients achieving 10% or more TBWL was 74%, 67%, 67%, and 69%, respectively. Analyses revealed the percent of TBWL at 3, 6 and 12 months to be independent predictors of percent of TBWL at 24 months, and predicted 39%, 45%, and 74% of the variability of percent of TBWL at 24 months, respectively. The odds of achieving 10% or more of TBWL at 24 months if a patient did not achieve it at 3 months was 0.21 (95% CI 0.054-0.81).

Investigators noted that maximum weight loss was generally achieved by 24 months after the procedure, and that patients tended to regain about 14% of their lost weight. "Failure to achieve significant weight loss within 3 months after ESG decreases the chance of subsequent weight loss by 80%," they reported.

Sharaiha told MD Mag that investigators found more significant and sustained TBWL with ESG than is associated with the intragastric balloon, and that their results were similar to those with AspireAssist. She emphasized, however "ensuring good compliance with diet is critical."

The study, tited "Long-Term Follow-Up and Outcomes after Endoscopic Sleeve Gastroplasty for Treatment of Obesity (5-year data)," was presented on at Digestive Disease Week (DDW) meeting in San Diego, CA.