Endoscopic Sleeve Gastroplasty as a therapeutic option for class III obesity

Aims The spread of Endoscopic Sleeve Gastroplasty (ESG) as an effective bariatric endoscopic technique has been notable, particularly for treating patients with class I and II obesity with related comorbidities. Our study aimed to assess the efficacy of ESG in class III obese patients [Body Mass index (BMI)>40 kg/m²] focusing on weight loss and comorbidities improvement.

Methods This retrospective analysis on a prospective dataset, focused on individuals with a baseline BMI>40 kg/m² who underwent ESG from January 2018 to November 2023. Weight loss outcomes [BMI, Excess Weight Loss (%EWL), Total Body Weight Loss (%TBWL), BMI loss (BMIL) and Absolute Weight Loss (AWL)] were assessed at 3, 6, 12 and 24 months. Additionally, the impact of ESG on Type 2 Diabetes (T2D), Hyperinsulinemia (H-INS), Arterial Hypertension (AH), and Obstructive Sleep Apnea Syndrome (OSAS) was analyzed.

Results A total of 129 patients with a BMI over 40 (74 female, mean age: 47±12.7, mean BMI: 44.4±4.1 kg/m²), who either declined surgery or were considered ineligible for surgical intervention, were included in the study. At the 24-month follow-up we observed a mean BMI reduction of 7.1±4.8 and a mean TBWL of 15.4%. At the 12-month follow-up, our data showed improvement or complete remission of Type 2 Diabetes (T2D), Hyperinsulinemia (H-INS), Arterial Hypertension (AH), Obstructive Sleep Apnea Syndrome (OSAS) in 50% (7/14), 42.4% (14/33), 56.2% (27/48) and 26% (7/27) of patients, respectively. No adverse events were documented.

Conclusions Based on our observations, while Endoscopic Sleeve Gastroplasty (ESG) demonstrated effectiveness in inducing weight loss and ameliorating comorbidities in class III obese patients, it did not fully resolve obesity, potentially due to the high baseline BMI. Consequently, surgical intervention should continue to be the primary treatment modality for class III obesity. However, when surgery is contraindicated or refused by the patient, ESG represents a less invasive option and could be considered as an effective first-stage or multi-step treatment.

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Artikel online veröffentlicht:
27. März 2025