Figure - available from: Obesity Surgery
This content is subject to copyright. Terms and conditions apply.
Forest plots comparing between endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy regarding: A overall adverse events and C gastroesophageal reflux disease. B Leave-one-out sensitivity analysis for overall adverse events by excluding Alqahtani et al.
Source publication
Introduction
Endoscopic sleeve gastroplasty (ESG) is a novel endoscopic bariatric therapy that complements current medical and surgical therapeutic offerings for weight management and fills an unmet need. Few meta-analyses compared ESG to laparoscopic sleeve gastrectomy (LSG). However, these studies relied on indirect evidence derived from non-comp...
Similar publications
Purpose
Staple line leakage (SLL) and staple line bleeding (SLB) are the most relevant postoperative complications of sleeve gastrectomy (SG). It is controversial whether and which method of staple line reinforcement (SLR) can best reduce these complications. The primary objective of this study was to investigate whether reinforcement of the most p...
Introduction
In the current opioid crisis, bariatric surgical patients are at increased risk of harms related to postoperative opioid overprescribing. This study aimed to assess the extent to which opioids prescribed at discharge after bariatric surgery are consumed by patients.
Methods
This multicenter prospective cohort study included adult pati...
Background
Fat mass index (FMI) is a body composition indicator that reflects body fat content. Laparoscopic sleeve gastrectomy (LSG) is widely performed in patients with obesity.
Objective
This study aimed to evaluate the value of the FMI in predicting weight loss effect and quality of life early after LSG.
Material and Methods
From January 2014...
Background
Gastric staple line leak treatment after laparoscopic sleeve gastrectomy (LSG) remains challenging. Regenerative medicine is gaining place in the accelerated treatment of damaged tissues. This study presents the first series of gastric leak treatment after LSG using endoscopic intragastric administration of combined autologous mesenchyma...
Background
Tranexamic acid (TXA) has drawn growing interest over the last decade for its benefit in optimizing post-operative bleeding, yet its role in bariatric surgery is poorly understood.
Methods
The medical librarian developed and executed comprehensive searches on September 28, 2022. The population of interest included adults who underwent e...
Citations
... For instance, ESG typically induces lower short-and mid-term weight loss when compared to LSG [14]. Surgical sleeve patients often lose 25-30% of total body weight (≈60-70% excess weight loss) in the first year or two after surgery and maintain superior long-term weight reduction in most comparative reports [14]. ...
... For instance, ESG typically induces lower short-and mid-term weight loss when compared to LSG [14]. Surgical sleeve patients often lose 25-30% of total body weight (≈60-70% excess weight loss) in the first year or two after surgery and maintain superior long-term weight reduction in most comparative reports [14]. Current evidence states that despite the current advancements in endoscopic techniques and the safety of ESG in "impenetrable" abdomen, showing fewer adverse events [15], ESG remains inferior to laparoscopic sleeve gastrectomy in the magnitude of weight reduction [14]. ...
... Surgical sleeve patients often lose 25-30% of total body weight (≈60-70% excess weight loss) in the first year or two after surgery and maintain superior long-term weight reduction in most comparative reports [14]. Current evidence states that despite the current advancements in endoscopic techniques and the safety of ESG in "impenetrable" abdomen, showing fewer adverse events [15], ESG remains inferior to laparoscopic sleeve gastrectomy in the magnitude of weight reduction [14]. Patients undergoing endoscopic therapies are more liable to recurrent weight gain, undermining their longterm effectiveness. ...
... La ESG es el procedimiento de remodelación gástrica más comúnmente realizado e implica colocar varias suturas en forma continua a lo largo de la curvatura mayor del estómago; también se puede colocar una segunda capa de suturas lineales como refuerzo (Figura 5). La evidencia existente hasta el momento ha mostrado eficacia en la pérdida total de peso entre el 16% y 20% a los 12 meses (30)(31)(32) y reducciones estadísticamente significativas en los niveles de presión arterial, circunferencia de la cintura, triglicéridos, niveles de hemoglobina glicosilada (HbA 1c ) e índice (29) . ...
Antecedentes: la obesidad es una enfermedad con alta prevalencia a nivel mundial, y su incidencia está en aumento, especialmente en los países de ingresos medios a altos. Su fisiopatología se encuentra relacionada con la regulación hormonal intestinal y diversas afecciones gastrointestinales. Introducción: el gastroenterólogo desempeña un papel importante en el tratamiento de esta enfermedad por medio de intervenciones especializadas como la endoscopia bariátrica, que contribuyen con la pérdida de peso y la disminución de las comorbilidades asociadas a esta condición. Además, debido a que cada vez más pacientes se someten a procedimientos para la pérdida de peso, es esencial comprender el tratamiento médico coadyuvante en los procedimientos bariátricos. En esta revisión se presentan los elementos clave que debe tener en cuenta el gastroenterólogo para el manejo de la obesidad con base en la literatura más reciente. Conclusiones: existen necesidades de tratamiento insatisfechas para los pacientes con obesidad, dentro de las cuales el abordaje con procedimientos endoscópicos bariátricos son una realidad considerando que se realicen en conjunto con otros abordajes de carácter multidisciplinario.
... Recent advancements in bariatric procedures include various endoscopic techniques that offer less invasive alternatives and other bariatric surgeries that have been recently introduced into the field. Among the endoscopic methods, endoscopic sleeve gastroplasty is one of the most popular and utilizes internal sutures to reduce the stomach volume, enhancing weight loss [7,8]. ...
Metabolic and bariatric surgery is widely recognized as the most effective and durable treatment for the disease of obesity and its associated comorbidities. In recent years, the field has seen significant advancements, introducing numerous innovative surgical options. This review aims to comprehensively examine these emerging surgical techniques, which have recently received endorsement from the American Society for Metabolic and Bariatric Surgery (ASMBS). Additionally, we will explore new technologies and methodologies supported by the latest scientific evidence. Our analysis will include a critical evaluation of the efficacy, safety, and long-term outcomes of these novel approaches, providing a detailed update on the current state of metabolic and bariatric surgery, highlighting key developments and their potential implications for clinical practice.
... Existing evidence indicates that ESG is associated with a lower complication Table S4 d Estimates of the prevalence of type 2 diabetes, hypertension, sleep apnea, non-alcoholic fatty liver disease, and gastro-esophageal reflux disease in each BMI group health state, and annual costs for the management of these comorbidities, were based on values identified through a targeted literature search (Tables S5-S7). These prevalence and annual cost estimates were combined to estimate the total comorbidity cost for each health state per annual model cycle ( rate than more invasive bariatric procedures such as laparoscopic sleeve gastrectomy [35]. The reasons for the underutilization of MBS in the US are multifactorial and complex, although a lack of insurance/health plan coverage, limited resources, and fear of complications with MBS are key patient-reported barriers to progressing to surgery [36]. ...
Purpose
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT.
Materials
We used a Markov modelling approach with BMI group health states and an absorbing death state. Baseline characteristics, utilities, BMI group transition probabilities, and adverse events (AEs) were informed by patient-level data from the MERIT RCT. Mortality was estimated by applying BMI-specific hazard ratios to US general population mortality rates. We used BMI-based health state utilities to reflect the impact of obesity comorbidities and applied disutilities due to ESG AEs. Costs included intervention costs, AE costs, and BMI-based annual direct healthcare costs to account for costs associated with obesity comorbidities. A willingness-to-pay threshold of 23,432/QALY. ESG remained cost-effective in all sensitivity analyses we conducted and was dominant in analyses with longer time horizons.
Conclusion
ESG is a cost-effective treatment option for people living with obesity and should be considered in commercial health plans as an additional treatment option for clinically eligible patients.
... A recent meta-analysis of 6775 patients reported a significantly lower incidence of de novo GERD after ESG compared to LSG, 1.3% vs. 17.9%, respectively [78]. De novo GERD has been noted with use of IGBs, likely related to the increase in intragastric pressure and pressure gradient across the LES. ...
Purpose of Review
Obesity and related comorbidities are on the rise, with trends showing that nearly half of the United States population will be obese by 2030. This review focuses on the pathophysiology of esophageal disorders in patients with obesity as well as treatment considerations for obesity in patients with esophageal disorders.
Recent Findings
Gastroesophageal reflux disease (GERD) is prevalent in approximately 20% of patients with obesity and is associated with multiple underlying anatomic risk factors. In addition, systemic and paracrine proinflammatory effects mediated by visceral adipose tissue also contribute to the development of GERD-related complications such as erosive esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma. Esophageal dysmotility is also common in obesity, although with varying clinical impact as the majority of patients are asymptomatic. Although data regarding laparoscopic sleeve gastrectomy and GERD is conflicting, Roux-en-Y gastric bypass is considered the preferred surgical approach for obesity in patients with GERD. Recent data signal that newer anti-obesity medications like glucagon-like peptide 1 (GLP-1) agonists may lead to increased GERD and related complications; however, data on this subject is limited.
Summary
Esophageal dysfunction is prevalent in patients with obesity and should be carefully evaluated prior to considering treatment for obesity such as bariatric surgery or antiobesity medications.
... ESG poses certain advantages over bariatric surgery in that it is not anatomy-altering and has a potentially better safety profile and hence may be carefully considered in patients with less severe disease (lower IMS score). 12 In patients with more severe disease, bariatric surgery should remain the treatment of choice. Our study provides pilot data on the use of a score that may help guide the appropriate selection of procedures for optimal and individualized treatment of patients with obesity and T2D; future studies with larger, comparative cohorts are required to establish these standards. ...
Plain language summary
Use of individualized metabolic surgery score in endoscopic sleeve gastroplasty
Why was the study done? Endoscopic sleeve gastroplasty (ESG) is effective and safe as a treatment for obesity and has also shown improvement in diabetes in previous studies. However, there is no data showing the rates of diabetes remission after this procedure and no measures to predict this outcome. This study uses the individualized metabolic score (IMS) to predict diabetes remission after ESG. What did the researchers do? They analyzed a sample of patients who had undergone ESG, and evaluated the change in their diabetes parameters at 1 year compared to baseline, and then correlated this with their calculated baseline IMS score. What did the researchers find? Patients with a higher IMS score, representing more severe disease, were less likely to have an improvement in their diabetes after ESG. What do the findings mean? ESG can be an effective treatment option for patients with obesity and early-stage diabetes.
... The most common side effects are nausea and vomiting and abdominal pain. Leakage and free fluid around the stomach, gastric bleeding, some cases of venous thromboembolism and other complications such as pneumotrax, pneumperitnyum have also been seen [27,28]. ...
... Contraindications for ESG, as with other endoscopic options for the treatment of obesity, include large hiatal hernia, gastric ulcer, gastric tumors or intestinal metaplasia, previous surgical procedure, pregnancy, continuous monitoring and anticoagulant use [27,28]. Image of the transpyloric shuttle in the stomach [26]. ...
... ESG provided clinically adequate but lower short-and medium-term weight loss and resulted in fewer adverse events, including GERD, compared to LSG. Given the gastroprotective nature of ESG and its acceptable safety profile, it may be considered as an alternative to LSG for patients with mild to moderate obesity [28]. ...
Obesity is a multifactorial, chronic disease that occurs with a pathologic increase in the body fat ratio and significantly increases mortality and morbidity. It has become a global health problem with increasing prevalence day by day. Methods used in the treatment of obesity are classified as diet, exercise, lifestyle changes, medical treatments, surgical treatments and endoscopic treatments. Endoscopic treatments are classified as intragastric balloon, transpyloric shuttle, endoscopic sleeve gastroplasty, gastric aspiration, small bowel procedures, duodenal mucosal resurfacing, intragastric botulinum toxin A injection. Although surgical procedures are known as the most effective methods in the fight against obesity today, the frequency and effectiveness of endoscopic treatments are increasing day by day. Endoscopic methods in obesity treatment are promising. There is a need for new methods with high efficacy and reliability, easy application, low complication rate and low cost in the treatment of obesity.
... In the last decade endoscopic sleeve gastroplasty (ESG) established itself as a valuable alternative to bariatric surgery in mildly to moderately obese patients. Although it has been associated with lower short-and mid-term weight loss when compared to LSG, it showed acceptable safety profile with fewer adverse events, including GERD [19]. Given its stomachsparing nature, ESG is a less-invasive, repeatable, and reversible and therefore, associated with a low morbidity and a shorter in-hospital length of stay [19][20][21]. ...
... Although it has been associated with lower short-and mid-term weight loss when compared to LSG, it showed acceptable safety profile with fewer adverse events, including GERD [19]. Given its stomachsparing nature, ESG is a less-invasive, repeatable, and reversible and therefore, associated with a low morbidity and a shorter in-hospital length of stay [19][20][21]. These features are making the ESG a very good potential candidate for the bridging therapy in selected patients with extreme obesity, especially when we have in mind a questionable IGB performance in these settings. ...
... The procedure generates similar gut hormonal changes to conventional bariatric surgery [7,8]. This fully endoscopic procedure has several appealing advantages compared to laparoscopic operations, including a truly scarless technique, shorter hospital stay and improved perioperative outcomes [9][10][11]. Endoscopic bariatric procedures could be an alternative solution to bariatric surgery in elderly or surgical unfit patients [12]. ...
This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. Overall, pooled short-term (12 months) total weight loss (TWL) was 16.2% (95% CI 13.1–19.4%) in 23 studies ( n = 5659). Pooled medium-term TWL was 15.4% (95% CI 13.7–17.2%) in 10 studies ( n = 4040). Diabetes resolution was 55.4% (95% CI 46–64%), hypertension resolution was 62.8% (95% CI 43–82%), dyslipidaemia resolution was 56.3% (95% CI 49–63%), and obstructive sleep apnoea resolution was 51.7% (95% CI 16.2–87.3%) in four studies ( n = 480). This pooled analysis demonstrates that ESG can induce durable weight loss and resolution of obesity-associated comorbidities in patients with moderate obesity.
Graphical Abstract
... Several bariatric procedures are available and used in UK clinical practice (including Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and gastric banding) [8]. However, these are invasive, associated with risk of post-operative complications, and hesitancy about undergoing surgery from the perspective of patients is common [5,9,10]. Further, only 20% of procedures recorded in the UK National Bariatric Surgery registry during 2013-2018 were performed as day cases, with patients typically requiring inpatient admission for 2 to 3 days [8]. ...
Background
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that has been demonstrated in the MERIT randomised, controlled trial to result in substantial and durable additional weight loss in adults with obesity compared with lifestyle modification (LM) alone. We sought to conduct the first cost-effectiveness analysis of ESG versus LM alone in adults with class II obesity (BMI 35.0–39.9 kg/m²) from a national healthcare system perspective in England based on results from this study.
Methods
A 6-state Markov model was developed comprising 5 BMI-based health states and an absorbing death state. Baseline characteristics, utilities, and transition probabilities were informed by patient-level data from the subset of patients with class II obesity in MERIT. Adverse events (AEs) were based on the MERIT safety population. Mortality was estimated by applying BMI-specific hazard ratios from the published literature to UK general population mortality rates. Utilities for the healthy weight and overweight health states were informed from the literature; disutility associated with increasing BMI in the class I-III obesity health states was estimated using MERIT utility data. Disutility due to AEs and the prevalence of obesity-related comorbidities were based on the literature. Costs included intervention costs, AE costs, and comorbidity costs.
Results
ESG resulted in higher overall costs than LM alone but led to an increase in quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for ESG vs LM alone was £2453/QALY gained. ESG was consistently cost effective across a wide range of sensitivity analyses, with no ICER estimate exceeding £10,000/QALY gained. In probabilistic sensitivity analysis, the mean ICER was £2502/QALY gained and ESG remained cost effective in 98.25% of iterations at a willingness-to-pay threshold of £20,000/QALY.
Conclusion
Our study indicates that ESG is highly cost effective versus LM alone for the treatment of adults with class II obesity in England.
