Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?

Abstract

Introduction ESG is an effective treatment option for obesity. However, data comparing its efficacy to bariatric surgery is scarce. We aim to compare the effectiveness and safety of ESG to LSG and LGCP at 2-years. Methods We reviewed 353 patient records and identified 296 patients who underwent ESG (n=199), LSG (n=61), and LGCP (n=36) at 4-centers in Spain between 2014 to 2016. We compared their total body weight loss (%TBWL) and safety over 2-years. We used a linear mixed model (LMM) to analyse repeated measures of weight loss outcomes at 6, 12, 18, and 24-months for comparison between the three procedures. Results Among the 296 patients, 210 (ESG-135, LSG-43, LGCP-32) reached 1-year and 102 (ESG-46, LSG-34, LGCP-22) patients completed 2-years follow-up. The mean(SD) BMI was 39.6(4.8) kg/m2. There was no difference in the age, sex, and BMI between the groups. In LMM analysis, adjusting for age, sex, and initial BMI, we found ESG had a significantly lower TBWL, %TBWL, and BMI decline compared to LSG and LGCP at all time points (p=0.001). The adjusted mean %TBWL at 2-years with ESG, LSG, and LGCP was 18.5%, 28.3%, and 26.9%, respectively. However, ESG, as compared to LSG and LGCP, had a shorter inpatient stay (1 vs.3 vs. 3 days, p<0.001) and lower complication rate (0.5% vs.4.9% vs. 8.3%, p=0.006). Conclusion All three procedures induced significant weight loss in obese patients. Although the weight loss was lower with ESG compared to other techniques, it displayed a better safety profile and shorter hospital stay.

Why are weight loss outcomes unequal despite similar reductions in gastric volume?

“…A fascinating observation in the study of Lopez-Nava et al was that, as early as 6 months after the procedure, a 10 % total body weight loss benefit was established for LSG and LGCP over ESG, which persisted through the 2 years of follow-up, as shown in Fig. 3 in their article [4]. If the variance observed was the result of suture dehiscence and loss of restriction in the ESG cohort over time, one might expect the weight loss profiles to be similar at 6 months between the three cohorts, with this being followed by the surgical cohorts steadily tracking superior weight loss over the remaining 18 months.…”

“…In this issue of Endoscopy, Lopez-Nava et al report the medium-to long-term results of a retrospective review of three procedures (two surgical [LSG and laparoscopic greater curvature plication (LGCP)] and one endoscopic [ESG]) that result in similar reductions in the gastric volume, as shown in Fig. 2 in their article [4]. Though the patient populations were unmatched, the strengths of this study are the similar post-procedure follow-up undertaken by all participants and the 2-year duration of follow-up.…”

“…Though the patient populations were unmatched, the strengths of this study are the similar post-procedure follow-up undertaken by all participants and the 2-year duration of follow-up. The authors arguably report the results in a somewhat biased manner by highlighting the clinically significant weight loss, shorter hospital stay, faster procedure time, and superior safety profile of ESG, instead of focusing on the primary outcome of the studythe comparative effectiveness of ESG vs. LGCP vs. LSG with respect to weight loss [4]. Nonetheless, despite the inferior efficacy of ESG compared with LSG and LGCP, it may be a cost-effective approach (at least in those who are non-morbidly obese and without severe metabolic disease, such as insulin-dependent diabetes mellitus) and further study with respect to this is warranted.…”

“…There are several insights that can be derived from comparative studies such as the one published [4]. First, the data acquired can be used by clinicians and patients to allow a datadriven conversation when deciding which weight loss technique should be performed.…”

“…Lopez-Nava et al did not investigate if there were any differences observed in the metabolic and gut hormone profile between the three cohorts [4]. However, they did previously evaluate the gut hormone profile in a small study comparing LSG with ESG [6].…”