Comments on “Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?”

We read with interest the article by Lopez-Nava et al. [1] and congratulate the authors for their unbiased comparative analysis of these similar-appearing weight loss procedures. Obesity and diabetes are multifactorial chronic diseases with risk factors that include genetic polymorphisms, environmental triggers, metabolic derangements, lifestyle changes, and behavioral components. These factors mandate a holistic approach to manage these disorders. Endoscopic sleeve gastroplasty (ESG) is relatively new and still evolving, with the longest available follow-up data being just a few years, as compared to the time-tested surgical bariatric procedures. As highlighted in a previous publication [2], most of the laparoscopic sleeve gastrectomy (LSG) recipients have weight regain or recidivism between the 2nd and 5th years. There is no significant literature regarding what happens to ESG patients beyond the 2nd year, except a single recent publication with 5 years of follow-up, which showed a mean total body weight loss (TBWL) of 15.9 %, with 61 % of patients maintaining at least 10 % TBWL [3]. Furthermore, even if we consider that both ESG and laparoscopic greater curve plication (LGCP) work by the same mechanism, LGCP showed better results at all time intervals (P = 0.001) [1]. The published literature suggests that LGCP does not promise long-term maintenance of weight loss [4], so can we anticipate similar long-term trends following ESG?

As this was a retrospective analysis of patients from 2014 to 2016, it is unclear why patients with less than 2 years of follow-up were included. The non-completers following ESG were substantially higher in number (64 and 89 at the end of the 1st and 2nd years, respectively) and could therefore have skewed the data. This high non-completion rate seems to have occurred as a result of significant drop-outs or non-follow-up, and it would be useful to understand why non-completers were substantially higher in this group compared with the laparoscopic surgery groups. Furthermore, it would also be interesting to know the current metabolic status of the ESG non-completers, which would add overall value to the current understanding and potential endorsement of ESG as a valid option for the treatment of obesity.

Publication History

Article published online:
25 February 2021

• References

• 1 Lopez-Nava G, Asokkumar R, Bautista-Castaño I. et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?. Endoscopy 2020; DOI: 10.1055/a-1224-7231.
• 2 Baig SJ, Priya P, Mahawar KK. et al. Weight regain after bariatric surgery–a multicentre study of 9617 patients from Indian Bariatric Surgery Outcome Reporting Group. Obes Surg 2019; 29: 1583-1592
• 3 Sharaiha RZ, Hajifathalian K, Kumar R. et al. Five-year outcomes of endoscopic sleeve gastroplasty for the treatment of obesity. Clin Gastroenterol Hepatol 2020; DOI: 10.1016/j.cgh.2020.09.055.
• 4 Talebpour M, Motamedi SM, Talebpour A. et al. Twelve year experience of laparoscopic gastric plication in morbid obesity: development of the technique and patient outcomes. Ann Surg Innov Res 2012; 6: 7