Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals

Barham K Abu Dayyeh; Andres Acosta; Michael Camilleri; Manpreet S Mundi; Elizabeth Rajan; Mark D Topazian; Christopher J Gostout

doi:10.1016/j.cgh.2015.12.030

Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals

Clin Gastroenterol Hepatol. 2017 Jan;15(1):37-43.e1. doi: 10.1016/j.cgh.2015.12.030. Epub 2015 Dec 31.

Authors

Barham K Abu Dayyeh¹, Andres Acosta², Michael Camilleri², Manpreet S Mundi³, Elizabeth Rajan⁴, Mark D Topazian⁴, Christopher J Gostout⁴

Affiliations

¹ Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Clinical Enteric Neuroscience Translational and Epidemiological Research, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: abudayyeh.barham@mayo.edu.
² Clinical Enteric Neuroscience Translational and Epidemiological Research, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
³ Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
⁴ Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.

PMID: 26748219
DOI: 10.1016/j.cgh.2015.12.030

Abstract

Background & aims: Although bariatric surgery is the most effective therapy for obesity, only a small proportion of candidates undergo this surgery. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that reduces the size of the gastric reservoir. We investigated its durability and effects on body weight and gastrointestinal function in a prospective study of obese individuals.

Methods: Twenty-five obese individuals (21 female; mean body mass index, 35.5 ± 2.6 kg/m²; mean age, 47.6 ± 10 years) underwent ESG with endoluminal creation of a sleeve along the gastric lesser curve from September 2012 through March 2015 at the Mayo Clinic in Rochester, Minnesota. Subjects were followed for a median period of 9 months. We measured changes in body weight and recorded adverse events; patients were assessed by endoscopy after 3 months. Four participants underwent pre-ESG and post-ESG analyses to measure solid and liquid gastric emptying, satiation (meal tolerance), and fasting and postprandial levels of insulin, glucose, and gut hormones.

Results: Subjects had lost 53% ± 17%, 56% ± 23%, 54% ± 40%, and 45% ± 41% of excess body weight at 6, 9, 12, and 20 months, respectively, after the procedure (P < .01). Endoscopy at 3 months showed intact gastroplasty in all subjects. After ESG, physiological analyses of 4 participants showed a decrease by 59% in caloric consumption to reach maximum fullness (P = .003), slowing of gastric emptying of solids (P = .03), and a trend toward increased insulin sensitivity (P = .06). Three patients had serious adverse events (a perigastric inflammatory collection, a pulmonary embolism, and a small pneumothorax) but made full recoveries with no need for surgical interventions. No further serious adverse events occurred after the technique was adjusted.

Conclusions: ESG delays gastric emptying, induces early satiation, and significantly reduces body weight. ESG could be an alternative to bariatric surgery for selected patients with obesity. ClincialTrials.gov number: NCT 01682733.

Trial registration: ClinicalTrials.gov NCT01682733.

Keywords: BMI; Gastric Restriction; Stomach; Weight Loss Procedure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Body Weight
Endoscopy / methods*
Female
Gastric Emptying
Gastrointestinal Hormones / blood
Gastroplasty / methods*
Humans
Hyperglycemia
Insulin / blood
Male
Middle Aged
Minnesota
Obesity / surgery*
Prospective Studies
Satiation
Stomach / physiology
Treatment Outcome

Substances

Gastrointestinal Hormones
Insulin

Associated data

ClinicalTrials.gov/NCT01682733