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Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body

Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body

Weight in Obese Individuals
Background & Aims
Although bariatric surgery is the most effective therapy for obesity, only a small proportion of candidates undergo this surgery.
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that reduces the size of the gastric reservoir. We
investigated its durability and effects on body weight and gastrointestinal function in a prospective study of obese individuals.


Methods
Twenty-five obese individuals (21 female; mean body mass index, 35.5 ± 2.6 kg/m2; mean age, 47.6 ± 10 years) underwent
ESG with endoluminal creation of a sleeve along the gastric lesser curve from September 2012 through March 2015 at the
Mayo Clinic in Rochester, Minnesota. Subjects were followed for a median period of 9 months. We measured changes in body
weight and recorded adverse events; patients were assessed by endoscopy after 3 months. Four participants underwent pre-
ESG and post-ESG analyses to measure solid and liquid gastric emptying, satiation (meal tolerance), and fasting and
postprandial levels of insulin, glucose, and gut hormones.
Results
Subjects had lost 53% ± 17%, 56% ± 23%, 54% ± 40%, and 45% ± 41% of excess body weight at 6, 9, 12, and 20 months,
respectively, after the procedure (P < .01). Endoscopy at 3 months showed intact gastroplasty in all subjects. After ESG,
physiological analyses of 4 participants showed a decrease by 59% in caloric consumption to reach maximum fullness (P = .
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003), slowing of gastric emptying of solids (P = .03), and a trend toward increased insulin sensitivity (P = .06). Three patients
had serious adverse events (a perigastric inflammatory collection, a pulmonary embolism, and a small pneumothorax) but
made full recoveries with no need for surgical interventions. No further serious adverse events occurred after the technique
was adjusted.
Conclusions
ESG delays gastric emptying, induces early satiation, and significantly reduces body weight. ESG could be an alternative to
bariatric surgery for selected patients with obesit