Post written by Vivek Kumbhari, MD, and Lea Fayad, MD, from the Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Our study compared 2 weight-loss procedures, the commonly performed laparoscopic sleeve gastrectomy (LSG) and the newly introduced, minimally invasive endoscopic sleeve gastroplasty (ESG).

The LSG has excellent weight-loss outcomes but, as an elective procedure, remains associated with adverse events which are disconcerting and make it less desirable to patients. New-onset gastroesophageal reflux disease (GERD) is a particular concern that has been associated with LSG. Additionally, a small proportion of those eligible for bariatric surgery opt for this therapy due to fear of complication and reluctance to undergo surgery. This leaves a large unmet need that could be addressed with minimally invasive endoscopic bariatric therapies (EBTs) such as endoscopic sleeve gastroplasty (ESG).

At the 6 months of follow-up, the percent total body weight loss was lower in the ESG group (17.1% ± 6.5%) compared with the LSG group (23.6% ± 7.6%). However, ESG patients had significantly lower rates of adverse events (5.2% vs 16.9%, P< .05). New-onset GERD was also significantly lower in the ESG group compared with the LSG group (1.9% vs 14.5%, P<.05).

Despite similar restriction in size in both procedures, the difference in weight loss outcomes remains to be explained and is likely related to the excision of the gastric mucosa in the LSG. Further prospective research must look into the physiologic differences that contribute to weight loss and to the development of GERD after these 2 procedures.

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