Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals.

Abstract

BACKGROUND & AIMS:

Although bariatric surgery is the most effective therapy for obesity, only a small proportion of candidates undergo this surgery. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that reduces the size of the gastric reservoir. We investigated its durability and effects on body weight and gastrointestinal function in a prospective study of obese individuals.

METHODS:

Twenty-five obese individuals (21 female; mean body mass index, 35.5 ± 2.6 kg/m2; mean age, 47.6 ± 10 years) underwent ESG with endoluminal creation of a sleeve along the gastric lesser curve from September 2012 through March 2015 at the Mayo Clinic in Rochester, Minnesota. Subjects were followed for a median period of 9 months. We measured changes in body weight and recorded adverse events; patients were assessed by endoscopy after 3 months. Four participants underwent pre-ESG and post-ESG analyses to measure solid and liquid gastric emptying, satiation (meal tolerance), and fasting and postprandial levels of insulin, glucose, and gut hormones.

RESULTS:

Subjects had lost 53% ± 17%, 56% ± 23%, 54% ± 40%, and 45% ± 41% of excess body weight at 6, 9, 12, and 20 months, respectively, after the procedure (P < .01). Endoscopy at 3 months showed intact gastroplasty in all subjects. After ESG, physiological analyses of 4 participants showed a decrease by 59% in caloric consumption to reach maximum fullness (P = .003), slowing of gastric emptying of solids (P = .03), and a trend toward increased insulin sensitivity (P = .06). Three patients had serious adverse events (a perigastric inflammatory collection, a pulmonary embolism, and a small pneumothorax) but made full recoveries with no need for surgical interventions. No further serious adverse events occurred after the technique was adjusted.

CONCLUSIONS:

ESG delays gastric emptying, induces early satiation, and significantly reduces body weight. ESG could be an alternative to bariatric surgery for selected patients with obesity. ClincialTrials.gov number: NCT 01682733.

• Authors: Barham K Abu Dayyeh, Andres Acosta, Michael Camilleri, Manpreet S Mundi, Elizabeth Rajan, Mark D Topazian, Christopher J Gostout
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 15 Issue 1 Pg. 37-43.e1 (01 2017) ISSN: 1542-7714 [Electronic] United States
• PMID: 26748219 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• Gastrointestinal Hormones
• Insulin

Topics

• Adult
• Aged
• Body Weight
• Endoscopy (methods)
• Female
• Gastric Emptying
• Gastrointestinal Hormones (blood)
• Gastroplasty (methods)
• Humans
• Hyperglycemia
• Insulin (blood)
• Male
• Middle Aged
• Minnesota
• Obesity (surgery)
• Prospective Studies
• Satiation
• Stomach (physiology)
• Treatment Outcome