*EMBARGOED All research presented at the ACG Annual Scientific Meeting is strictly embargoed until Monday, October 17, 2016 at 8:00 am EDT.
Poster 2135 The Skinny on Endoscopic Sleeve Gastroplasty: A Single Center Experience for the Treatment of Obesity in 91 Patients
Author Insight from Reem Sharaiha MD, MSc, and Monica Saumoy, MD, Weill Cornell Medicine, New York Presbyterian Hospital
What’s new here and important for clinicians?
There are many different methods for weight loss including lifestyle modification, medication therapy and surgical therapy. But the last 10 years have given rise to many endobariatric therapies. Each method has shown varying levels of success for weight loss. However the most important benefit derived from each method is not just the weight loss itself, but also the improvement of other associated medical comorbidities. For example, bariatric surgery in particular has shown significant success in the improvement of diabetes, hypertension and hyperlipidemia. Our study, in addition to demonstrating successful weight loss, is to date the most comprehensive study that demonstrates an endoscopic weight loss procedure can also improve obesity-related comorbidities.
We demonstrate the largest single-center case series that has been published to date for the endoscopic sleeve gastroplasty (ESG). ESG is a novel, incisionless minimally invasive bariatric procedure performed via an endoscope that reduces the length and width of the gastric cavity. Clinical success was defined as 25% excess weight loss (%EWL) measured at 12 months or a TBWL of at least 15%. Our case series demonstrated an 88.5% success rate. But more importantly, we demonstrated successful improvements in anthropometrics and clinical biomarkers 12 months after ESG. In patients with diabetes or pre-diabetes, there was a significant reduction in HgA1c (mean ± SD 6.6 % ± 1.2 vs 5.6 %±0.51, respectively, p=0.02). In addition, there were significant reductions in systolic blood pressure (129.0 ± 13.4 mmHg vs. 122.2 ± 11.69 mmHg (p=0.02), TG (131.84 ± 83.19 mmol/dL vs 92.36 ± 39.43 mmol/dL (p=0.02), and ALT (42.4 ± 18.0 vs 22.8 ±16.3 mg/dL, p=0.05, in men and 28.0 ± 14.0 vs 20.1 ± 10.2 mg/dL in women, p=0.01).
This study is the first ESG study to examine metabolic profiles of patients. Given the growing obesity epidemic and the rising cost of health care in the United States, there is increased demand for less-invasive bariatric therapies. ESG has evolved into a same-day, outpatient endoscopic procedure with a significant impact on weight loss and a low rate of adverse events. This study highlights that endobariatric procedures, particularly the endoscopic sleeve gastroplasty, can also have successful impact on long-term outcomes, including morbidity and mortality, and is another alternative for clinicians and patients to consider for weight management.
What do patients need to know?
Obesity is a disease that requires a multidisciplinary approach to manage. In addition to diet and exercise, many patients also undergo surgical procedures to aid in weight loss. However, the endoscopic sleeve gastroplasty has been developed as an alternative to surgery. The endoscopic sleeve gastroplasty is a novel bariatric procedure that facilitates weight loss via an incisionless and minimally invasive endoscopic approach to decrease the size of the stomach.
There have been many documented reasons that patients who are eligible for bariatric surgery have cited as why they are not interested in a surgical approach. Two of the commonly indicated reasons are fear of surgery and concerns with cost. The endoscopic sleeve gastroplasty is an endoscopic procedure that does not require a surgical operation. In addition, the endoscopic sleeve gastroplasty is a less costly option because it is an outpatient procedure.
To date, published case series have only shown successful weight loss in small numbers of patients. This study, however, is the largest published case series that demonstrates successful weight loss, and that endoscopic weight loss procedures can also cause improvement in medical comorbidities such as diabetes, hypertension and hypertriglyceridemia. Therefore, we demonstrate that the endoscopic sleeve gastroplasty is a viable alternative for patients who would benefit from a bariatric weight loss procedure.
Reem Sharaiha MD, MSc, Weill Cornell Medicine, New York Presbyterian Hospital
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