Endoscopic Sleeve Gastroplasty for management of Obesity in patient suffer from Inflammatory Bowel Disease

Aims Obesity is a multifactorial, chronic, and relapsing disease, and its prevalence among patients with inflammatory bowel disease (IBD) is increasing, affecting 15–40% of them [1] [2]. Limited data are available on the outcomes of endoscopic sleeve gastroplasty (ESG), a non-malabsorptive, organ-sparing endoscopic procedure, in patients with IBD [3] [4]

Methods We conducted a retrospective review of a prospective dataset of subjects who underwent ESG at a tertiary center, including all subjects affected by IBD. Weight loss and IBD outcomes were assessed during early- and medium-term follow-up.

Results Ten subjects (80% women) with IBD (5 with ulcerative colitis and 5 with Crohn's disease) underwent ESG between October 2019 and May 2024 (mean BMI 37.6±3.75 kg/m², mean age 49.4±12.3 years). Four patients (40%) had previously undergone IBD-related surgery. Seven patients (70%) had received biological therapy, and six (60%) were in clinical remission at the time of ESG. No perioperative adverse events occurred.

At the 6-month follow-up, nine subjects experienced total body weight loss (TBWL) of>10%, with a mean excess weight loss (EWL) of 55.9±29.6%. Nine patients reached the 12-month follow-up, with a TBWL of 17.3±10.5% (6 of them with TBWL>10%). At the final follow-up (mean 20.25±3.46 months), the mean TBWL was 12.3±10.2%, and the mean EWL was 38.2±31.8%. Three patients underwent endoscopic revision for recurrent weight gain after a mean of 21 months. Two of these patients reached the 6-month follow-up with a mean TBWL of 9.89±0.15% and EWL of 46.83±1.79%. Overall, eight (80%) patients had no change in their IBD medication, one (10%) required treatment escalation due to loss of response. One subject, affected by chronic kidney disease and with a history of ileocecal resection, required emergency surgery for bowel obstruction caused by an incisional hernia 16 months after ESG. Unfortunately, four months later, he died due to septic shock. At the last follow-up, eight (89%) of the nine patients were in clinical remission, and all patients were in steroid-free remission.

Conclusions We present the largest series on ESG in patients with IBD and obesity. Based on these retrospective data, ESG appears to be a promising bariatric procedure for these complex patients due to its safety and efficacy. However, prospective studies and clinical trials are needed to confirm these findings.

Publication History

Article published online:
27 March 2025

• References

• 1 Johnson AM, Storm AC, Mahmoud T. et al. Endoscopic Bariatric Therapies for the Management of Obesity in Patients with Inflammatory Bowel Disease. OBES SURG 2023; 33 (2): 676-681
• 2 Pugliese D, Schepis T, Bove V, Privitera G, Boskoski I, Armuzzi A.. Morbidly Obese Patient With Ulcerative Colitis Treated With Endoscopic Gastroplasty: A Case Report. Inflammatory Bowel Diseases 2021; 27 (4): e49-e50
• 3 Singh S, Dulai PS, Zarrinpar A, Ramamoorthy S, Sandborn WJ.. Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes. Nat Rev Gastroenterol Hepatol 2017; 14 (2): 110-121
• 4 Johnson AM, Loftus EV.. Impact of Obesity on the Management of Inflammatory Bowel Disease. Gastroenterology & Hepatology 2020; 16 (7): 350