Three-year outcomes of Endoscopic Sleeve Gastroplasty by obesity class

Aims Obesity is a chronic and recurrent disease. Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive technique to fill the therapeutic gap between medical and surgical approaches to treat obesity [1] [2]. In this study, we aim to report real-world long-term outcomes of ESG for all class obesity to further implement the evidence of long-term effectiveness.

Methods A retrospective analysis was performed on a prospective database including patients with obesity (BMI≥30 kg/m²) who underwent ESG (May 2017-May 2021) at a single tertiary Center. Weight loss outcomes (%EWL,%TBWL) were evaluated during follow-up and stratified according to obesity class. As per routine clinical practice, all patients were included in a multidisciplinary follow-up scheduled at 1, 3, 6, and then every 6 months [3].

Results Between May 2017 and May 2021, 252 subjects (73% Female) underwent ESG with a median BMI of 37.2 (35.3-40.8) kg/m² at baseline and a median age of 45 (36-54) years. No severe procedure-related adverse events occurred. Of 252 subjects, 58 (23%) had class I (BMI 30-34.9), 120 (48%) had class II (BMI 35-39.9), and 74 (29%) had class III obesity (BMI≥40). Patients with class I obesity showed a median%EWL of 49.7% (30.4-66.3) at 12 months, 39.3% (18.1-58.6) at 24 months, and 31.3% (6.4-54.7) at 30-36 months. Similarly, median%TBWL was 12.5% (6.5-19.4) at 12 months, 15.9% (10.3-21.3) at 24 months, and 11.1% (4.5-18.3) at 30-36 months. Patients with class II obesity showed a median%EWL of 50.8% (32.7-64.0) at 12 months, 41.5% (14.4-60.8) at 24 months, and 31.4% (13.0-54.8) at 30-36 months. Parallelly,%TBWL was 16.3% (10.5-22.4), 13.8% (4.5-18.9), and 10.7% (4.4-18.2) at 12, 24, and 30-36 months, respectively. Patients with class III obesity reported a median%EWL of 45.2% (27.8-57.1), 31.3% (17.5-49.3), 31.4% (13.0-49.3) at 12, 24, and 30-36 months. In addition,%TBWL was 16.2% (10.5-22.6), 15.1% (7.6-22.9), and 10.7% (4.4-18.2) at 12, 24, and 30-36 months. Further, 77% of patients with class I, 68% of patients with class II, and 42% of patients with class III obesity achieved the efficacy threshold of%EWL>5% at 3 years³. Similarly, 77% of patients with class I, 75% of those with class II and 61% of those with class III achieved the threshold of%TBWL>5% associated with obesity-related comorbidities improvement.

Conclusions Our experience confirms that ESG, in the setting of a real-world multidisciplinary approach, is a safe and effective procedure for treating obesity, associated with sustained weight loss in all obesity classes.

Publication History

Article published online:
27 March 2025

• References

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