Post written by Vitor Ottoboni Brunaldi, MD, MSc, PhD, from the Gastroenterology and Hepatology Division, Mayo Clinic, Rochester, Minnesota, USA, Surgery and Anatomy Department, Ribeirao Preto Medical School, University of Sao Paulo, and Gastrointestinal Endoscopy Unit, University of Sao Paulo Medical School, Brazil.

This study investigated the efficacy of endoscopic sleeve gastroplasty (ESG) in inducing weight loss and body mass index (BMI) normalization for an overweight population. The study also focused on evaluating the safety of the procedure in this subset of patients.

With more than 15,000 procedures described in the literature and level 1 data supporting its efficacy, there was little doubt as to the role of ESG in the current armamentarium against obesity. However, there was still no evidence to support its use in overweight patients.

As prevention and early interventions have increasingly become the mainstay of any health policy, we decided to investigate the outcomes of performing ESG in patients at an earlier stage of the disease. If proven effective and safe, it could halt the progression from overweight to obesity.

Our study population was comprised of 189 patients from 9 centers (6 in the United States, 1 in Brazil, 1 in Mexico, and 1 in India) across the globe. At 24 months, the percent total weight loss (%TWL) was around 15% for a BMI normalization rate of 86% at the most extended follow-up. The %TWL reported was in accordance with the literature describing ESG for obesity.

The serious adverse event rate was extremely low, lower than typically reported in the same literature. These data suggest that ESG is equally effective for obese and overweight populations but safer for the latter (probably related to a lower baseline overall risk).

Next, we should look at more extended follow-ups (5 and 10 years) and compare weight trends against similar baseline BMI and age populations. By doing so, we could assert that ESG, if used early in the natural history of the disease, could divert patients from reaching obesity thresholds.

Weight loss outcomes including only patients attending all visits. A, Means for the 95 individuals attending all visits from 6 months through 36 months. B, Means for the 184 individuals attending all visits 6 months through 24 months. BMI, Body mass index; %TWL, percent total weight loss.

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