Endoscopic sleeve gastroplasty induces and maintains weight loss in mild to moderate obesity

August 03, 2022

2 minute read


Disclosures: Abu Dayyeh reports consulting roles for BFKW, Endogenex, Endo-TAGSS and Metamodix; a consulting role and grants or research support from Boston Scientific, Spatz Medical, and USGI; speaking roles for Johnson and Johnson and Olympus; speaker fees and grants or research support from Endogastric Solutions and Medtronic; and research support from Apollo Endosurgery, Aspire Bariatrics and Cairn Diagnostics.

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According to research published in The Lancet.

“Endoscopic sleeve gastroplasty (ESG) is a procedure that is performed through the mouth with an endoscope to reduce the size of the stomach for weight loss and metabolic improvement in diseases such as diabetes”, Barham K. Abu DayyehMD, MPH, director of advanced endoscopy and professor of gastroenterology and hepatology at Mayo Clinic in Rochester, Minnesota, Healio told Healio. “This intervention does not require surgery and preserves the stomach; unlike surgery, the stomach is not cut and removed. Thus, the procedure is an attractive and minimally invasive option for many patients suffering from the disease of obesity.

“While hundreds of publications and abstracts have been published on the experience of ESG, there remained a need for a prospective randomized trial demonstrating efficacy in a control group, in accordance with joint medical and surgical guidelines dating from 2011 “, did he declare. “We also needed to better understand the impact of the procedure on obesity-related comorbidities.”

In the ESG Multicenter Randomized Interventional Trial (MERIT), Abu Dayyeh and colleagues explored the safety and effectiveness of ESG plus lifestyle modifications compared to lifestyle modifications alone. The primary endpoint was percent excess weight loss (EWL) at 52 weeks, while secondary endpoints included change in metabolic comorbidities between groups. Patients in the control group who did not achieve the LEF goal of at least 25% weight loss were offered ESG, with follow-up for an additional 52 weeks after the crossover. Patients in the ESG group were followed for 104 weeks.

Of 187 participants included in the modified intention-to-treat analysis, 77 underwent SAE with lifestyle modifications and 110 underwent lifestyle modifications alone. At 52 weeks, 49.2% of patients in the ESG group and 3.2% of patients in the control group achieved the primary endpoint, with a mean percentage total body weight loss of 13.6% and 0. 8%, respectively.

Compared to the control group, a higher percentage of patients in the ESG group also achieved 25% or more LEP (77% vs. 12%) and had improvement in one or more metabolic comorbidities (80% vs. 45%) . However, 12% of patients in the SAE group and 50% of patients in the control group presented with aggravated comorbidities.

As often seen with traditional bariatric surgery, Abu Dayyeh noted that patients with conditions such as diabetes, hypertension and metabolic syndrome showed clinically significant improvement, with “additional improvements in eating behaviors, depression and quality of life.

Of the 60 patients in the ESG group who achieved at least 25% LEP, 68% maintained this weight loss at 104 weeks. Additionally, the weight loss trajectory in patients who switched to the ESG group also improved, with participants achieving an average LEP of 44.1% at 52 weeks post-switch. SAE-related serious adverse events occurred in three of the 131 participants.

“Studies investigating the cost-effectiveness of this endoscopic procedure compared to traditional surgical options could have a significant impact on how insurance companies view it as an option for obese patients,” Abu Dayyeh said. “Further research should also focus on combination therapies with pharmacotherapies and ESG together to have an even deeper impact on weight loss and improvement of comorbidities.”

He continued, “ESG has opened up an opportunity for providers and their patients struggling with obesity, many of whom have tried unsuccessfully to lose weight by changing their diet and lifestyle and are not interested. or candidates for bariatric surgery. We now have a procedure that is not only less invasive, but also safe, effective, and most importantly, organ-sparing.

“As gastroenterologists and surgeons, we now have the opportunity to offer patients an endoscopic procedure that does not require the removal or permanent modification of the gastrointestinal tract, while producing significant weight loss and a metabolic benefit.”

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