Laparoscopic sleeve gastrectomy enhances weight loss results

Laparoscopic sleeve gastrectomy enhances weight loss results

A randomized trial found that obese patients who underwent endoscopic sleeve gastrectomy (ESG) in combination with lifestyle changes experienced greater weight loss than lifestyle changes alone, and also experienced improvements in their comorbidities.

In an average intent-to-treat analysis of 187 patients, those who underwent lifestyle modification plus ESG shed significantly more weight at 52 weeks compared to individuals who only underwent lifestyle modification (49.2% vs. 4.5%), a difference of more than double. Study threshold for successs<0.001), according to Dr. Barham Abu Dayyeh, of the Mayo Clinic in Rochester, Minnesota.

The mean total weight loss was 13% greater at this time point in the ESG group (s<0.001) and these patients were able to maintain approximately (91%) weight loss up to week 104 (median 12.4%), he said in a presentation at the annual meeting of Digestive Diseases Week (DDW).

In addition, the ESG group experienced improvement in type 2 diabetes (93% vs 15% with lifestyle modification alone), metabolic syndrome (83% vs 35%), and hypertension (67% vs 40%).

ESG is a luminal endoscopic procedure to preserve the stomach and is used as a treatment option for obesity. Safety and efficacy have been demonstrated in previous studies, but there is still a lack of consensus regarding technique, training, and patient management before and after the procedureAnd According to the latest research.

“We need more organ-preserving, safe and effective interventions,” Abu Dayyeh said, adding that these interventions should be easy to adhere to for patients, especially during the pandemic.

He explained, “The endoscopic sleeve is an oral procedure that is performed using a full-thickness suture device to create a greater curvature of the stomach in order to change it into a tubular shape that affects the appetite pathways.” “This procedure preserves the stomach’s neurovascular supply and motility and is therefore an anatomy-preserving option for weight loss and comorbidities management.”

In the trial, ESG was associated with significant improvement in quality of life, eating behaviors, and depression, without any deterioration in gastroesophageal reflux disease, and 80% reported that they would definitely recommend it to a friend or family member with obesity.

Roberto Simmons Linares, MD, of the Cleveland Clinic in Ohio, who was not involved in this study.

“Patients’ satisfaction was very high,” he added. “Patients with obesity and healthcare providers dealing with obesity and metabolic syndrome should be aware that ESG is a great option.”

The study randomly assigned 208 adults with a BMI of 30-40 (median 35.7) at nine US centers for ‘moderate-intensity’ lifestyle modification using ESG for 52 weeks (n = 77) or for lifestyle modification alone (n = 110).

After 52 weeks, 72 patients of the control group crossed to receive ESG and achieved similar weight loss results as the initial ESG arm (44% excess weight loss).

The ESG alone achieved its target threshold of 25% after demonstrating a 49% excess weight loss. The response rate among ESG patients who achieved the excess weight loss threshold was 77%. Among the responders, the total weight loss was 16%.

The study found an improvement in insulin resistance and hyperlipidemia with ESG, with HbA1c significantly improved by an average of 1.65%.

Serious adverse events—perigastric abscess, upper gastrointestinal bleeding, and malnutrition—occurred in three patients (2%) in the ESG group, all resolved without sequelae or any deaths, and 4% were hospitalized for post-operative accommodative symptom management.

Of those patients who did not obtain the primary outcome, 14 underwent reconstitution. None of them required other surgical interventions, blood transfusions, or intensive care.

  • Zina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She resides in Chicago.


Abu Dayyeh disclosed his ties to Apollo Endosurgery, Aspire Bariatrics, Boston Scientific, BFKW, Cairn, EndoGastric Solutions, Endogenex, GI Dynamics, Johnson & Johnson, Medigus, Medtronic, Metamodix, Olympus, Spatz and USGI.

2022-05-25 18:32:25

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