Reply to Katakwar et al.

We appreciate the thoughtful comments raised by Katakwar et al. concerning our recent study. Our study’s objective was to provide a rational view of the role of endoscopic sleeve gastroplasty (ESG) in the care continuum of obesity [1]. ESG, as a long-term weight loss option, is yet to be studied. We anticipate some of the sutures may dehisce completely by 2 years, leading to gastric dilatation. A similar progressive, adaptive gastric dilatation has also been observed as early as 12 months after laparoscopic sleeve gastrectomy (LSG) [2]. In support of this, our study showed the maximum weight loss in all three procedures occurred in the first 18 months and then regressed to the 6-month values.

We included all the patients in the analysis to avoid selection bias. We adjusted for follow-up loss, baseline confounding variables, and center differences using a linear mixed model and provided a precise point estimate of percentage total body weight loss (%TBWL) at different time points. We acknowledge the follow-up losses in the ESG group. Attaining an 80 % follow-up rate would be ideal; however, achieving even this was a challenge in the combined bariatric surgery group at 2 years (follow-up rate 57 %).

In a logistic regression analysis, follow-up completion at 2 years was predicted only by the procedure type (bariatric surgery more than ESG; b = 0.36, 95 % confidence interval [CI] 0.18 – 0.72; P = 0.004), but not by the baseline age, sex, body mass index, or %TBWL at 1 year. We attribute the follow-up loss with ESG to two reasons. First, 25 % of the ESG patients who dropped out were from other provinces of Spain. Second, the cost associated with each visit for ESG is not covered by insurance.

We have previously shown that, with weight loss (> 10 %), there is an improvement in insulin resistance and the insulin secretory pattern [3]. The mean %TBWL (95 %CI) in the non-completer group was 16.9 % (14.7 – 19.0) at 1 year, suggesting it is sufficient to demonstrate improvement in co-morbidities. The COVID-19 pandemic restricted us from obtaining the current status of co-morbidities in non-completers.

We hope that this information addresses the query raised by Katakwar et al.

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 Disse E, Pasquer A, Pelascini E. et al. Dilatation of sleeve gastrectomy: myth or reality?. Obes Surg 2017; 27: 30-37
• 3 Lopez-Nava G, Negi A, Bautista-Castaño I. et al. Gut and metabolic hormones changes after endoscopic sleeve gastroplasty (ESG) vs. laparoscopic sleeve gastrectomy (LSG). Obes Surg 2020; 30: 2642-2651