General surgery

Endoscopic sleeve gastroplasty (ESG), a relatively new, minimally invasive weight-loss procedure, resulted in significant total body weight loss in the first long-term study to follow patients’ progress over five years, according to research presented at Digestive Disease Week (DDW) 2019. Researchers hope these results will help solve a serious “treatment gap” for more than 100 million Americans with obesity who are unwilling or ineligible for traditional bariatric surgery.

Endoscopic sleeve gastroplasty

“We found very sustainable, significant weight loss for over 200 patients between the one- and five-year mark; losing an average of up to 15 to 20% of total body weight;” said Reem Sharaiha, MD, MSc, lead researcher on the study and attending physician at NewYork-Presbyterian/Weill Cornell Medical Center, associate professor of medicine in the divison of gastroenterology and hepatology at Weill Cornell Medicine, New York, New York.

“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. So, we hope this will persuade insurance companies that ESG is not ‘experimental,’ but has value over patients’ lifespan.”

Improvement in blood pressure

Dr. Sharaiha’s team was one of the first in the nation to perform ESG, a one-day outpatient procedure using a suturing device attached to an endoscope, over six years ago. She described it as “a series of sutures, cinching the stomach like an accordion, down to the size of a banana.” Afterward, she said, “You eat less, you feel full and you lose weight. And, there are no scars.”

Previous studies tracked ESG results for only one to two years, compared to this five-year prospectively collected data that tracked annual weight loss for 203 obese patients who underwent ESG between August 2013 and October 2018. Participants had a body mass index (BMI) between 32 and 46. Obesity is defined as a body mass index; or BMI score of 30 or more; morbid obesity is 40 or more.

Researchers observed that patients generally achieved maximum weight loss within 24 months, after which some patients tended to regain about 14% of their lost weight, similar to what is seen in the surgical literature. The study also found that failure to lose at least 10% of body weight within the first three months after ESG decreased the chance of subsequent significant weight loss by 80%.

Randomized control trial

The research showed less than 1% complications, an improvement over surgical procedures.”We felt that a longer-term study was needed to make sure weight loss is sustainable with this method of treatment. Research shows that if you keep weight off for an extended period; you’re more likely to keep it off permanently;” said Dr. Sharaiha.
“In terms of future studies; we will continue watching this cohort to track their progress over the next 10 to 20 years. Additionally; we are looking at hormonal responses and comorbidities; and are working to predict the best candidates who will benefit from this procedure. A randomized control trial that looks at ESG in combination with diet and exercise is also currently underway.”