Endoscopic Sleeve Gastroplasty Durable at 10 Years

PHILADELPHIA — New data showed durable weight loss of about 10% at 10 years after endoscopic sleeve gastroplasty (ESG) in adults with obesity.

“The procedure is dependable and safe and should be considered among individuals who have not attained their desired results through lifestyle medications and those who are not eligible for or choose not to undergo bariatric procedures,” said Ali Lahooti, with the Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City. He presented his research at the American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting.

Obesity is a growing global health challenge. Lifestyle modification as a stand-alone therapy has limited effectiveness achieving weight loss. Pharmacotherapies are more efficacious, but they’re also associated with higher costs of and risk for side effects, leading to lower rates of compliance, Lahooti explained.

Bariatric surgery remains the most effective therapy for management of obesity and improvement of comorbid conditions, yet

“Endoscopic treatments for obesity, such as ESG, can potentially fill this gap by combining durable weight loss with lower risk and costs,” Lahooti said.

He and his colleagues assessed outcomes out to 10 years in 404 patients (mean age, 45 years; 76% women; mean body mass index, 37.3) who underwent ESG between 2013 and 2024 at a single large tertiary hospital.

Out of the 404 patients, 397, 335, 249, and 110 patients were eligible for 1-, 3-, 5-, and 10-year follow-up, with complete follow-up rates of 85%, 66%, 79%, and 62%, respectively.

The primary outcome was weight loss at 10 years after ESG reported at percent total body weight loss (%TBWL).

At 10 years, mean %TBWL (the primary outcome) was 10.5% — with 53% of patients maintaining at least 5% TBWL and 42% maintaining at least 10% weight loss, Lahooti reported.

ESG had a favorable safety profile; 20% of patients experienced mild abdominal pain, constipation, heartburn, and nausea after the procedure that typically resolved within 2 weeks of the procedure.

“There were a total of three moderate adverse events — two perigastric leaks, one repaired endoscopically, and another that only required antibiotics,” Lahooti reported. There were no severe or fatal adverse events.

About 11% of patients had endoscopic revision via retightening or resuturing at 10 years, the study team noted in their conference abstract.

Bariatric Surgery Remains Gold Standard

Lahooti shared that in his experience, some patients will need a revision at “about 40 months,” but at the same time, he’s seen some patients at 10 years “and their sutures are still in place.”

Session co-moderator Shivangi Kothari, MD, with the Center for Advanced Therapeutic Endoscopy, University of Rochester Medical Center, Rochester, New York, congratulated Lahooti for providing “robust” long-term data on ESG and said, “there is a need for more studies like this.”

In an interview with Medscape Medical News, Ann M. Rogers, MD, president of the American Society for Metabolic and Bariatric Surgery, noted that bariatric surgery remains the “gold standard for weight loss and metabolic improvements,” with studies showing “around 30%” TWBL at 10 years compared with about 10% at 10 years in this study.

Another key caveat, said Rogers, is that there are practical barriers to ESG; insurance typically does not cover the procedure because they view it as “cosmetic.”

The study had no commercial funding. Lahooti and Rogers had no relevant disclosures.