Endoscopic Sleeve Gastroplasty as a Nonsurgical Weight Loss Alternative

According to the findings of a new study, endoscopic sleeve gastroplasty (ESG) could present an effective alternative to more invasive surgical weight loss interventions. The research was presented at Digestive Disease Week 2017, held May 6-9 in Chicago.

 

ESG reduces gastric volume by using an endoscopic suturing system inserted in the throat to place pleated sutures in the stomach that cause it to constrict like an accordion. Lead study author Reem Z. Sharaiha, MD, MSc, assistant professor of medicine at Weill Cornell Medicine and attending physician at New York-Presbyterian/Weill Cornell Medical Center, described it as “a day procedure done in the endoscopy suite” that leaves “no scars from the outside and no cuts.”

 

In contrast, traditional weight loss procedures, like laparoscopic sleeve gastrectomy (LSG) or laparoscopic band (LAGB) placement, are surgical interventions that involve cutting into the stomach. The researchers hypothesized that ESG would be similarly safe and effective as the other 2 procedures while requiring a shorter hospital stay and costing less.

 

The study followed obese patients with a body mass index (BMI) over 30 as they underwent either ESG, LSG, or LAGB. The investigators watched for outcomes like periprocedural morbidity, length of stay, and readmission rates. The patient groups were similar in terms of age, gender, and diabetes prevalence, but the ESG patients had a lower average BMI than the other 2 groups (38.8 kg/m² vs 47.3 and 45.7 for LSG and LABG, respectively). Patients in the LSG and LAGB groups were also more likely to have hypertension or hyperlipidemia.

 

Twelve months after the procedure, the LSG group had lost the most weight as a percentage of body weight (29.28%), but ESG (17.57%) and LAGB (14.46%) also resulted in considerable weight loss. Notably, post-procedure morbidity, or the occurrence of complications, was significantly lower in the ESG group than in the LSG or LAGB groups. Complications were observed in just 1% of the ESG patients, while 10% of LSG and 11% of LAGB patients experienced complications.

 

Patients undergoing ESG stayed in the hospital for an average of just 0.13 days, since it was performed in the outpatient endoscopy suite, compared to 3.09 days for LSG and 1.68 for LAGB. Finally, ESG costs around $12,000, while LAGB costs $15,000 and LSG costs $22,000 on average.

 

According to Sharaiha, the researchers’ data has shown that ESG tends to be more successful in younger patients and patients who have not previously had any gastric surgery. The study team continues to track long-term data to search for other predictors of success that will hopefully help clinicians counsel each new patient on what treatment would be best for them. They are “also going to partake in a randomized controlled study comparing ESG to lifestyle therapy.”

 

The follow-up studies could potentially impact reimbursement for weight loss procedures, as most insurance plans do not currently cover weight loss procedures. Sharaiha suggested that payers are waiting for more data, and “hopefully we’re producing a lot of data out there to show that this is a viable option.” Because obesity is a chronic disease, she envisions that ESG could be part of the various treatments an obese person undergoes throughout his or her lifetime.

 

When asked about the possible role of ESG as a tool to combat the obesity epidemic, Sharaiha emphasized that rising obesity rates must be fought from various aspects, “from medication, from diet and exercise, from a public health perspective,” but clinicians “need to offer patients multiple options,” including surgery. While her research demonstrated that traditional surgical procedures have successful weight loss outcomes, it also shows alternatives like ESG are a viable option for patients battling obesity.