The Efficacy and Safety of Endoscopic Sleeve Gastroplasty as an Alternative to Laparoscopic Sleeve Gastrectomy

Abstract

Endoscopic sleeve gastroplasty (ESG) is a therapeutic endoscopic technique for reducing the size of the gastric reservoir in obese patients, using a full-thickness endoscopic suturing device. The effectiveness of ESG in weight loss is significantly greater than that of high-intensity diet and lifestyle therapy and lower than that of laparoscopic sleeve gastrectomy (LSG). The efficacy at 12 months after ESG in terms of percentage of total body weight loss and excess body weight loss was approximately 16% and 60%, respectively. The well-known predictive factors for increased weight loss by ESG are good compliance with regular monitoring and post-procedure care involving a multidisciplinary team approach. Although the underlying mechanism of weight loss induced by ESG is debatable, delayed gastric emptying and early satiation are some of the proposed mechanisms. The pooled rate of adverse events after ESG reported in several meta-analysis studies ranged from 1.5% to 2.3% and the incidence of new-onset gastroesophageal reflux disease after ESG was negligible, indicating that ESG has a superior safety profile to LSG. Moreover, ESG reduced the risk of obesity-related metabolic comorbidities, evidenced by the reduction in HbA1c level, systolic blood pressure, triglyceride level, and risk of hepatic steatosis and fibrosis; it even improved the quality of life. ESG could be considered safe and qualify as an alternative treatment to LSG.

Advantages and disadvantages of endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy

“…risk-free and acceptable as an LSG substitute. 16 Similarly, Fiorillo et al revealed in their findings that LSG may have a major negative impact on quality of life and aggravate gastrointestinal problems, such as GERD. ESG is a promising bariatric endoscopic treatment that is less intrusive and has shown to improve quality of life and comorbidities, which may make it more acceptable to patients earlier in their disease or when they are younger.…”

The Effect of Endoscopic Bariatric and Metabolic Therapies on Gastroesophageal Reflux Disease

“…An expert consensus indicated that GERD is a contraindication to LSG [ 37 ]. The possible causes of LSG inducing GERD are low maximal distal contraction integral and low resting esophageal sphincter pressure [ 13 , 38 ]. Fayad et al showed how ESG and LSG affect GERD [ 32 ].…”

“…EBMT reduces weight and ameliorates obesity-associated complications [ 12 , 13 ]. However, EBMTs can result in adverse events, including nausea, abdominal pain, and gastroesophageal reflux disease (GERD) [ 12 , 13 ].…”

“…EBMT reduces weight and ameliorates obesity-associated complications [ 12 , 13 ]. However, EBMTs can result in adverse events, including nausea, abdominal pain, and gastroesophageal reflux disease (GERD) [ 12 , 13 ]. GERD may diminish when EBMT is performed on obese patients because GERD may occur due to obesity, but GERD may also worsen due to the EBMT even though the patient has lost weight.…”

Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments

“…We aim to review the various EBMT techniques, focusing on non-balloon and non-gastroplasty devices, as the use of those devices is well described elsewhere in this issue of Clinical Endoscopy. 7,8 We will discuss the possible mechanisms of action, efficacy, and safety profiles of these EBMT methods.…”