Endoscopic sleeve gastroplasty linked to lasting weight loss without surgery

By Megan Brooks

NEW YORK (Reuters Health) - 15/5/2019

Endoscopic sleeve gastroplasty was associated with significant weight loss in the first long-term study to follow patients over five years, report researchers from NewYork-Presbyterian/Weill Cornell Medical Center.

"Millions of Americans with obesity are either ineligible or unwilling to undergo traditional bariatric surgery," Dr. Reem Sharaiha said during a press briefing at Digestive Disease Week in San Diego, California, where she reported the results May 9.

Endoscopic sleeve gastroplasty (ESG) is a relatively new minimally invasive weight-loss procedure that uses an endoscopic suturing system to reduce the size of the stomach "and offers patients an alternative to bariatric surgery," she explained.

The researchers tracked annual weight loss out to five years for 203 obese patients who underwent ESG.

At one year (73% follow-up rate), weight loss was 18.1 kg, with total body weight loss (TBWL) of 15.2%. At two years (80% follow-up rate), weight loss was 17.3 kg, with 14.5% TBWL. At three years (64% follow-up rate), weight loss was 20.8 kg, with TBWL of 15.7% and at five years (89% follow-up rate), weight loss was 18.7 kg with 14.5% TBWL, Dr. Sharaiha reported.

At one, two, three and five years, 74%, 67%, 67% and 69% of patients lost 10% or more of total body weight.

"Our study showed very sustainable significant weight loss for our patients between the one- and five-year mark, with an average 15% average total body weight loss out to five years and this is statistically significant," Dr. Sharaiha told the briefing.

"This is significant because studies have shown that when people lose at least 10% of their body weight, they see improvement in blood pressure, diabetes and heart outcomes. We hope these findings will persuade insurance companies that ESG is not experimental but has value over patients' lifespan," she added.

Dr. Eric DeMaria, president of the American Society for Metabolic and Bariatric Surgery, told Reuters Health by email that ESG is "gaining some degree of acceptance but has not become widely available as it is still being evaluated. For example, the American Society for Metabolic and Bariatric Surgery still considers this procedure to be in the emerging category and does not yet endorse its performance without having patients sign a specialized consent form indicating the procedure is still under study."

"Patients benefit from the entire procedure being performed with a gastroscope without abdominal incisions. The risk of complications has been shown to be very low with the ESG procedure and recovery is quite rapid," said Dr. DeMaria, who is professor and chief of the division of general/bariatric surgery at East Carolina University in Greenville, North Carolina.

"The current study by Dr. Sharaiha's group provides meaningful data in that weight loss was found to persist 3-5 years following the ESG procedure. It is important to point out that how this procedure fits into the treatment options for obesity is still being debated as weight loss is lower than more traditional surgical procedures like sleeve gastrectomy and gastric bypass in which patients can often lose closer to 100 lbs or even more," said Dr. DeMaria.

"In contrast, this study suggests that ESG patients lose about 15% of their body weight at 5 years which would translate to 45 lbs of weight loss, on average, for a 300 lb patient. While providing some health benefits, this degree of weight loss would leave a 300 lb patient still in the obesity category after ESG. Thus, ESG is likely to be most useful for lower-body-weight patients, particularly those who do not meet traditional weight criteria for surgery, for example patients who are only 50-70 lbs over weight," Dr. DeMaria said.

"Patients in this lower range of obesity face many treatment challenges including rarely having insurance coverage for traditional surgery. With ESG, lower-body-weight patients may lose enough weight to experience the benefits of a weight-loss intervention at an overall lower out-of-pocket cost than the more-effective traditional operations," he added.

SOURCE: http://bit.ly/2LAsnpw

Digestive Disease Week 2019.

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