Endoscopic Sleeve Gastroplasty for Obesity Treatment: Two Years of Experience

Abstract

Background:Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim: To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Method:Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or <25% and adverse effects. Voluntary oral contrasted radiological examinations were scheduled to assess the gastroplasty at different times post-procedure. Results:Mean age was 44.9 (23-69) years. At 24 months after the procedure baseline mean BMI change from 38.3 to 30.8 kg/m2. TBWL, %TBWL and %EWL were of 21.3 kg, 19.5% and 60.4% respectively. 85.7% of patients achieve the goal of >25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up. Conclusion:Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up.

Multicenter study on the safety of bariatric endoscopy

“…In the first series reported, using the older model, three isolated complications were encountered (perigastric collection, lung embolism, pneumothorax), which were solved with medical treatment (30). No other complications have been reported in the other series reported so far (31)(32)(33)(34)(35), nor regarding the initial experience of 55 cases in our series.…”

Endoscopic sleeve gastroplasty: The learning curve

“…This point is further evidenced in the variation of median and mean procedure times in the current literature, which ranges from 75 to 157 minutes, in series of 20 and 10 patients, respectively [2,4,5]. Currently, it is not possible to compare other reports of an ESG learning curve to this one, as there are no published reports to date.…”

“…Unless contraindications appeared to be likely based on clinical history and physical examination, no endoscopic assessment was performed prior to ESG. Contraindications for ESG include prior gastric surgery, gastric ulceration, acute gastritis, anticoagulation, pregnancy, and psychiatric disorders that pose a substantial risk of interfering with the patient's ability to follow post-procedural instructions or make the recommended lifestyle adjustments post-ESG [1,4,5]. Patients were given an electronic prescription 2 weeks prior to the procedure, which included omeprazole 40 mg qD to be taken 1 week pre-ESG and for 6 weeks post-ESG, emend (aprepitant) 125 mg to be taken 3 hours prior to ESG, emend (Aprepitant) 80 mg qD to be taken the day after the procedure, hyoscyamine (Levsin) 0.125 mg 1 tab q 6 h as needed for cramping post-ESG, and ondansetron (Zofran) 4 mg sublingual tab 1 tab q 6 h as needed for nausea post-ESG.…”

“…All ESG procedures were performed as described by LopezNava et al [4,5,8] and Sharaiha et al [2]. The suture line was first marked with argon plasma coagulation (APC) along the anterior wall, greater curvature, and posterior wall.…”

“…This results in the gastric cavity forming a tubular structure along the lesser curvature, with the greater curvature closed off by plications from the gastroesophogeal junction to the prepyloric antrum [3,4,7]. Weight loss has been found to be durable at 1-year follow up [5].…”