Suture pattern does not influence outcomes of endoscopic sleeve gastroplasty in obese patients

 

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Abstract

Background and study aims ESG is an effective and safe medium-term procedure for obesity treatment. A variety of suture patterns have been reported. We aimed to compare whether there are differences in efficacy depending on suture pattern used.

Patients and methods Retrospective and comparative review of 5 years of prospectively collected data, including consecutive obese patients undergoing ESG at two collaborative centers. Primary outcomes included weight loss (mainly % total body weight loss [TBWL] and % exces weight loss [EWL]) at 12 months and safety profile. We compared them according to three suture patterns (transverse bilinear [TBp], longitudinal [Lp] and transverse monolinear [TMp]), and number of sutures (4 – 7) and stitches (< 25, 25 to 30 and > 30) applied. Evolution of major obesity-associated morbidities (hypertension, dyslipidemia, Type 2 diabetes mellitus (T2DM), sleep obstructive apnea syndrome, and arthropathy) were also described.

Results 88 patients (mean age 46.1±12.3 years, 69.3 % female) underwent ESG. Mean body mass index (BMI) at baseline was 39.40 ± 4.69 kg/m². At 1 year, %TBWL was 17.36 ± 6.09 % (%EWL 46.41±20.6 %) with TBWL > 10 % in 95.5 % of patients (EWL > 25 % in 94.3 % of patients). According to pattern, there were no differences in %TBWL but there were in %EWL (43.7 ± 20.4 %, 59.8 ± 18.9 % and 45.4 ± 14.9 % in TBp, Lp and TMp patterns, respectively) (P = 0.034). No differences were found related to number of sutures (mean 5.2 ± 0.73, r = 4 – 7) or stitches (mean 27.4 ± 6.50, r = 18 – 50) applied. Forty-three of 72 (59.7 %) major comorbidities were resolved. No serious adverse events were observed with any pattern.

Conclusions ESG is an effective procedure at 12-month follow-up for weight loss and comorbidity resolution. All three analyzed patterns are safe and effective without differences in %TBWL, but there was a slight increase in %EWL in Lp, regardless of the number of sutures or stitches applied.

Publication History

Received: 24 April 2020

Accepted: 12 June 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Hill C, Khashab MA, Kalloo AN. et al. Endoluminal weight loss and metabolic therapies: current and future techniques. Ann N Y Acad Sci 2018; 1411: 36-52
  CrossrefPubMedGoogle Scholar
• 2 Kumar N, Sahdala HNP, Shaikh S. et al. Endoscopic sleeve gastroplasty for primary therapy of obesity: initial human cases. Gastroenterology 2014; 146: S571-S2
  CrossrefPubMedGoogle Scholar
• 3 Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc 2013; 78: 530-535
  CrossrefPubMedGoogle Scholar
• 4 Hedjoudje A, Dayyeh BA, Cheskin LJ. et al. Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2020; 18: 1043-1053
  CrossrefPubMedGoogle Scholar
• 5 Singh S, Hourneaux de Moura DT, Khan A. et al. Safety and efficacy of endoscopic sleeve gastroplasty worldwide for treatment of obesity: a systematic review and meta-analysis. Surg Obes Relat Dis 2020; 16: 340-351
  CrossrefPubMedGoogle Scholar
• 6 Li P, Ma B, Gong S. et al. Efficacy and safety of endoscopic sleeve gastroplasty for obesity patients: a meta-analysis. Surg Endosc 2020; 34: 1253-1260
  CrossrefPubMedGoogle Scholar
• 7 Gys B, Plaeke P, Lamme B. et al. Endoscopic gastric plication for morbid obesity: a systematic review and meta-analysis of published data over time. Obes Surg 2019; 29: 3021-3029
  CrossrefPubMedGoogle Scholar
• 8 Espinet Coll E, López-Nava Breviere G, Nebreda Durán J. et al. Spanish Consensus Document on Bariatric Endoscopy. Part 1. General considerations. Rev Esp Enferm Dig 2018; 110: 386-399
  CrossrefPubMedGoogle Scholar
• 9 Alberti KG, Eckel RH, Grundy SM. et al. International Diabetes Federation Task Force on Epidemiology and Prevention. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645
  CrossrefPubMedGoogle Scholar
• 10 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187-196
  CrossrefPubMedGoogle Scholar
• 11 Abu Dayyeh BK, Acosta A, Camilleri M. et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol 2017; 15: 36-43.e1
  CrossrefPubMedGoogle Scholar
• 12 Hajifathalian K, Ang B, Dawod QM. et al. Long-term follow up and outcomes after endoscopic sleeve gastroplasty for treatment of obesity (5 year data). Gastrointest Endosc 2019; 6: AB58
  CrossrefPubMedGoogle Scholar
• 13 Lopez-Nava G, Sharaiha RZ, Vargas EJ. et al. Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up. Obes Surg 2017; 27: 2649-2655
  CrossrefPubMedGoogle Scholar
• 14 Alqahtani A, Al-Darwish A, Mahmoud AE. et al. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc 2019; 89: 1132-1138
  CrossrefPubMedGoogle Scholar
• 15 Sharaiha RZ, Kumta NA, Saumoy M. et al. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol 2017; 15: 504-510
  CrossrefPubMedGoogle Scholar
• 16 Graus Morales J, Crespo Pérez L, Marques A. et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc 2018; 32: 3936-3942
  CrossrefPubMedGoogle Scholar
• 17 Glaysher MA, Moekotte AL, Kelly J. Endoscopic sleeve gastroplasty: a modified technique with greater curvature compression sutures. Endosc Int Open 2019; 7: E1303-E1309
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Hill CH, El Zein M, Agnihotri A. et al. Endoscopic sleeve gastroplasty: the learning curve. Endosc Int Open 2017; 5: E900-E904
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Espinet Coll E, Vila Lolo C, Díaz Galán P. et al. Bariatric and metabolic endoscopy in the handling of fatty liver disease. A new emerging approach?. Rev Esp Enferm Dig 2019; 111: 283-293
  CrossrefPubMedGoogle Scholar
• 20 Sullivan S, Swain JM, Woodman G. et al. Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: The ESSENTIAL trial. Obesity (Silver Spring) 2017; 25: 294-301
  CrossrefPubMedGoogle Scholar
• 21 Khan Z, Khan MA, Hajifathalian K. et al. Efficacy of endoscopic interventions for the management of obesity: a meta-analysis to compare endoscopic sleeve gastroplasty, aspire assist, and primary obesity surgery endolumenal. Obes Surg 2019; 29: 2287-2298
  CrossrefPubMedGoogle Scholar
• 22 Huberty V, Machytka E, Boškoski I. et al. Endoscopic gastric reduction with an endoluminal suturing device: a multicenter prospective trial with 1-year follow-up. Endoscopy 2018; 50: 1156-1162
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Lopez-Nava G, Asokkumar R, Rull A. et al. Safety and feasibility of a novel endoscopic suturing device (EndoZip TM) for treatment of obesity: first-in-human study. Obes Surg 2020; 30: 1696-1703
  CrossrefPubMedGoogle Scholar
• 24 Wannhoff A, Hofmann C, Meier B. et al. Endoscopic sleeve gastroplasty for severe obesity by full-thickness suturing using the GERDX device. Endoscopy 2019; 51: E34-E35
  Article in Thieme ConnectPubMedGoogle Scholar
• 25 Brethauer SA, Chand B, Schauer PR. et al. Transoral gastric volume reduction as intervention for weight management: 12-month follow-up of TRIM trial. Surg Obes Relat Dis 2012; 8: 296-303
  CrossrefPubMedGoogle Scholar
• 26 Fayad L, Adam A, Schweitzer M. et al. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc 2019; 89: 782-788
  CrossrefPubMedGoogle Scholar