Endoscopic Sleeve Gastroplasty (ESG) is an incisionless transoral endoscopic procedure whereby a gastric luminal sleeve is fashioned by application of a series of transmural sutures placed along the greater curvature of the stomach resulting in a reduction in functional gastric volume. The study aimed to report on 12-month outcomes following ESG for weight loss.
We analysed 121 consecutive patients who underwent ESG from October 2016 to January 2018. All procedures were performed using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Patient outcomes included Total Body Weight Loss (TBWL), weight circumference reduction (ΔWC), body composition change measured by DXA, and immediate and delayed adverse events.
ESG resulted in 17% TBWL and ΔWC 14.8 cm by 12 months (19.6% TBWL and 17.6 cm ΔWC among patients never had endoscopic bariatric procedure). For 77 patients where DXA body composition data were available, fat mass was reduced amongst all patients whereas fat-free mass was increased amongst 61% of patients. By six months, patients lost 29% of their total body fat mass (12.6 kg absolute loss) and 55% reduction in visceral fat mass (1.1 kg) and there was an average increased lean body mass by 3% (1.3 kg). The Fat Mass vs. Fat-Free Mass ratio dropped from 0.7 (baseline) to 0.5 (6 months). Predictors of poor outcomes include being in the learning curve stage and previous experience with endoscopic bariatric treatment; the predictor of better weight loss outcome was higher frequency of consultation with allied health professionals. There were no major intraprocedural or post-procedural complications. The most commonly reported early adverse symptoms included cramping (50.4%), nausea (28.9%), abdominal pain (22.3%), and vomiting (5.8%).
ESG results in clinically significant weight loss and body composition improvements at 12 months follow-up with low risk of major complications. Its efficacy is enhanced by more intensive adjuvant lifestyle intervention.