Safety and early efficacy of endoscopic sleeve gastroplasty (ESG) for obesity in a multi‐ethnic Asian population in Singapore

Abstract

Background and Aim: Endoscopic sleeve gastroplasty (ESG) is an alternative nonsurgical treatment option for obesity. However, most studies on the utility and efficacy of ESG are derived from the Western population. It is unknown if ESG elicits similar results in Asians with different fat distribution, sociocultural customs, and dietary practices. Our study aims to assess the safety and efficacy of ESG among a multiethnic Asian population. Methods: We reviewed 35 patient records who underwent primary ESG for obesity at our unit. We followed a U-shaped suture pattern. Our primary outcome was to assess technical feasibility and safety. The secondary outcome was to determine the percentage total body weight loss (TBWL) at the last follow-up. Results: The mean AE SD age and body mass index were 43.6 AE 11.3 years and 34 AE 4.9 kg/m 2 , respectively. The majority were female (57%) and of Chinese ethnicity (51%). The procedure was technically successful in all patients. We used an average of five sutures (range, 4-7), and the mean AE SD procedure time was 65 AE 10 min. No major complications occurred, and the average length of stay was 1 day. Twenty-one patients completed 3 months of follow-up, and 10 patients 6 months. The mean AE SD TBWL at 3 and 6 months were 14.5 AE 4.8% and 16.2 AE 4.9%, respectively. We observed improvement in diabetes mellitus (87%), fatty liver (86%), and hypertension (58%) during the follow-up. Conclusion: ESG is a safe and effective option for promoting weight loss in a multiethnic Asian population. ESG-induced weight loss may improve obesity-related comorbidities.

Current treatment landscape for obesity in Singapore

“…None developed serious complications. [ 56 ] Our experience is aligned with the MERIT RCT and other published studies describing the short- and medium-term efficacy (5 years) of ESG together with an excellent safety profile (complication rate <2%). [ 57 58 59 ] The reversible nature of ESG and its positive impact on quality of life have extended its application to the adolescent population.…”

Novel Endoscopic Bariatric Therapies for the Management of Nonalcoholic Steatohepatitis

“…39,40 A Singaporean study of 35 patients who underwent primary ESG for obesity found improvement in hepatic transaminases in 86% of the patients during follow-up. 41 This was also seen in a study of 91 patients, which demonstrated improvements in glycated hemoglobin, systolic blood pressure, triglycerides, and alanine aminotransferase (ALT), suggesting improvement of metabolic dysfunction and liver steatosis after ESG. 42 In another single-center prospective study in India, 26 patients were studied post-ESG and found to have significant improvement in transaminases and multiple noninvasive scores for detection of fibrosis in patients with NAFLD (NAFLD fibrosis score, FIB-4 score, and AST [aspartate transaminase] to platelet ratio index) at 6 and 12 months.…”

“…LSG has been proven to be effective in the management of hepatic steatosis and NASH, and hence there is a growing interest in use of ESG for the same [39,40]. A Singaporean study of 35 patients who underwent primary ESG for obesity found improvement in hepatic transaminases in 86% of the patients during follow-up [41]. This was also seen in a study of 91 patients, which demonstrated improvements in glycated hemoglobin, systolic blood pressure, triglycerides and alanine aminotransferase (ALT) suggesting improvement of metabolic…”

Endoscopic sleeve gastroplasty using the novel single‐channel suturing device: A multicenter experience

“…We encouraged protein intake (1.5 g/kg/day) to prevent lean muscle mass. 11,13 In the first two weeks post-ESG, we encouraged patients to walk and restrict techniques that increased intraabdominal pressure. Subsequently, depending on the patient's capacity, we devised an individualized exercise plan, such as a treadmill, stair-climbing, jumping jacks, and squats (approximately 30-45 min/day).…”

“…We progressively advanced to semi‐solid and solid food based on patient tolerance. We encouraged protein intake (1.5 g/kg/day) to prevent lean muscle mass 11,13 . In the first two weeks post‐ESG, we encouraged patients to walk and restrict techniques that increased intra‐abdominal pressure.…”