Aims Bariatric procedures are often utilized for obesity. Combining resleeve endoscopic
gastroplasty with GLP-1 agonists is a novel approach to achieving long-term weight
loss, but its extended efficacy on weight reduction, metabolic health, liver function,
and gastrointestinal issues, such as gastroesophageal reflux disease (GERD), requires
further evaluation. GLP-1 agonists, such as Semaglutide, have been widely researched
for their ability to enhance the outcomes of endoscopic and surgical bariatric procedures
by suppressing appetite, promoting satiety, and exerting beneficial metabolic effects.
We aim to assess the long-term effects of this combined therapeutic approach on liver
function, as evidenced by changes in triglyceride levels and liver enzymes was also
examined in this study.
Methods This is a prospective clinical trial that examines the long-term outcomes of the
pre and post re-sleeve gastroplasty in combination with the GLP-1 agonists over a
24-month period. All recruited patients who met the inclusion criteria were properly
consented and monitored thought the study period of 24 months. Multiple variables
were studied including changes in patient weight, liver enzymes, and insulin resistance
indicators. Testing for statistically significant differences between means of continuous
variables grouped by a categorical variable (procedure type) was performed using the
ANOVA test. Testing for statistically significant differences among categorical variables
was performed using the Chi-sq test.
Results The study cohort included 48 patients, mostly females (n=41) with a mean age of 36
years, who underwent the resleeve procedure with GLP-1 agonist therapy. The most common
comorbidity was steatosis (n=28), followed by diabetes mellitus (n=21). Most patients
had 3 sutures. The mean weight decreased consistently throughout the study period,
from a decrease of 5.9±1.9 kg at 1 month follow up to 18.4±4.6 kg at 24 months follow
up. Meanwhile, GLP and HOMA-IR were mostly unchanged at 24 months. Mean triglyceride,
ALT, and AST levels all decreased at 24 months, although a slight increase in mean
ALT was noted at 12 months. Similarly, mean Fibroscan scores and BFM decreased at
12 and 24 months. The prevalence of GERD was significantly reduced in the study population,
with some patients experiencing full resolution of symptoms. No significant risks
of medullary thyroid cancer were identified. Physical exercise and dietary adherence
contributed to improved metabolic outcomes [1]
[2].
Conclusions Resleeve endoscopic gastroplasty with GLP-1 agonists is a compelling long-term intervention
for weight loss, improving metabolic and liver health while significantly reducing
GERD prevalence. These findings support the potential of this combined approach in
managing obesity and its related comorbidities. However, the minimal changes observed
in insulin resistance markers highlight the need for personalized therapeutic strategies
to maximize the metabolic benefits and fully address insulin resistance.
