New data shows effective long-term weight loss outcomes for people who have the endoscopic sleeve gastroplasty (ESG) procedure. The minimally invasive weight loss procedure, also known as the accordion procedure, could offer hope for those who can’t or don’t want to undergo traditional bariatric surgery.
The data is part of the first long-term study on more than 200 patients between one and five years after the procedure. Research led by Dr. Reem Sharaiha, an attending physician at New York-Presbyterian/Weill Cornell Medical Center, found that people lost an average of 15 to 20 percent of their total body weight as a result of the procedure.
“This is significant because studies have shown that when people lose at least 10 percent of their body weight, they see improvement in blood pressure, diabetes, and heart outcomes. So, we hope this will persuade insurance companies that ESG is not ‘experimental,’ but has value over patients’ lifespan,” Sharaiha said.
The data is being presented at Digestive Disease Week (DDW) 2019.
Sharaiha was on a team that was one of the first in the United States to perform the one-day outpatient procedure.
It involves inserting an endoscope that has a suturing device attached to it. The doctor creates a series of sutures in the patient’s stomach and then cinches them in a fashion similar to an accordion. The sutures change the structure of the stomach so it’s shaped like a tube. That can restrict the amount of food a person can eat, and the calories their body absorbs.
Previous research only evaluated ESG results for one or two years. The new study offers data from 203 obese patients who had the procedure done between 2013 and 2018. Participants had a body mass index (BMI) between 32 and 46. Obesity is defined as a BMI of 30 or more, while morbid obesity is 40 or more.
Most patients reached their maximum weight loss within a 24-month span. After that, they tended to regain about 14 percent of the weight they lost. They noted that people who didn’t lose at least 10 percent of their body weight within three months of the procedure had a lower chance of subsequent significant weight loss by 80 percent. Compared to other surgical procedures for weight loss, the research found that less than 1 percent of people had complications.
“Research shows that if you keep weight off for an extended period, you’re more likely to keep it off permanently,” Sharaiha said. She plans to track the participants’ progress over the next 10 to 20 years.
A randomized control trial to evaluate ESG in combination with diet and exercise is also currently underway, as are other studies on ESG.
Sharaiha told Healthline the procedure has grown in popularity over the last few years. It takes a certain skill set to perform it, but she finds more doctors are willing to learn how to perform it, she said.
ESG differs from surgical laparoscopic sleeve gastrectomy (LSG) because LSG removes a portion of the stomach while ESG “folds” the stomach.
Laparoscopic adjustable gastric banding involves inserting an inflatable balloon in the upper part of the stomach to create a pouch above it to restrict the amount of food the stomach can hold.
Gastric bypass creates a smaller stomach and connects part of the divided small intestine to it further down so stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.
Biliopancreatic diversion with duodenal switch creates creating a smaller stomach and bypassing much of the small intestine.
ESG patients can’t go on to have an intragastric balloon inserted after the procedure, though they can go on to have surgery, Sharaiha noted.
Dr. Manoel Galvao Neto, a clinical associate professor at Herbert Wertheim College of Medicine at Florida International University and not affiliated with the research, told Healthline that patients who have less severe obesity are expected to be better choices for ESG.
Severely obese patients have a more severe disease and therefore do better with bariatric surgery because it’s more powerful.
“Patients with a BMI greater than 40 should consider bariatric surgery over endoscopic sleeve gastroplasty due to the amount of excess weight loss required,” noted Dr. Nikhil A. Kumta, director of the Surgical and Bariatric Endoscopy Program at Mount Sinai Hospital.
He noted a recent
Patients with a BMI between 30 and 40 who need to lose 25 to 40 pounds are excellent candidates for ESG.
“It has also been shown to help with other co-morbidities such as hypertension, dyslipidemia, and diabetes. Patients are able to reduce the dosage of their medications to treat those conditions, if not discontinue the medications altogether,” Kumta told Healthline.
“A major disadvantage is the lack of insurance coverage and the cost of the procedure,” he added.
Sharaiha hopes her research will change that so more patients can have another weight loss option.
“The study showed me that even with different follow up, the procedure is durable. We saw great results for a relatively safe procedure,” she said.
A new study has found that endoscopic sleeve gastroplasty (ESG) can help people lose up to a fifth of their body weight. Researchers found that people lost an average of 15 to 20 percent of their total body weight as a result of the procedure.
Most patients reached their maximum weight loss within a 24-month span. After that, they tended to regain about 14 percent of the weight they lost.