Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
Clin Gastroenterol Hepatol. 2017 Apr;15(4):504-510. doi: 10.1016/j.cgh.2016.12.012. Epub 2016 Dec 23.
BACKGROUND & AIMS: Endoscopic sleeve gastroplasty (ESG) is an incisionless, minimally invasive bariatric procedure that reduces the length and width of the gastric cavity to facilitate weight loss. We performed a prospective study to evaluate the effects of ESG on total body weight loss and obesity-related comorbidities.
We collected data from 91 consecutive patients (mean age, 43.86 ± 11.26 years; 68% female) undergoing ESG from August 2013 through March 2016. All patients had a body mass index (BMI) greater than 30 kg/m and had failed noninvasive weight-loss measures or had a BMI greater than 40 kg/m and were not considered as surgical candidates or refused surgery. All procedures were performed with a cap-based flexible endoscopic suturing system to facilitate a triangular pattern of sutures to imbricate the greater curvature of the stomach. Patients were evaluated after 6 months (n = 73), 12 months (n = 53), and 24 months (n = 12) for anthropometric features (BMI, weight, waist circumference, blood pressure) and underwent serologic (hemoglobin A1c), lipid panel, serum triglycerides, and liver function tests. The primary outcomes were total body weight loss at 6, 12, and 24 months. Secondary outcomes were the effects of ESG on metabolic factors (blood pressure, diabetes, hyperlipidemia, steatohepatitis) and safety.
The patients' mean BMI before the procedure was 40.7 ± 7.0 kg/m. Patients had lost 14.4% of their total body weight at 6 months (80% follow-up rate), 17.6% at 12 months (76% follow-up rate), and 20.9% at 24 months (66% follow-up rate) after ESG. At 12 months after ESG, patients had statistically significant reductions in levels of hemoglobin A1c (P = .01), systolic blood pressure (P = .02), waist circumference (P < .001), alanine aminotransferase (P < .001), and serum triglycerides (P = .02). However, there was no significant change in low-density lipoprotein after vs before ESG (P = .79). There was one serious adverse event (1.1%) (perigastric leak) that occurred that was managed non-operatively.
ESG is a minimally invasive and effective endoscopic weight loss intervention. In addition to sustained total body weight loss up to 24 months, ESG reduced markers of hypertension, diabetes, and hypertriglyceridemia.
内镜袖状胃成形术（ESG）是一种无切口、微创减重手术，可缩小胃腔的长度和宽度，促进体重减轻。我们进行了一项前瞻性研究，以评估 ESG 对总体体重减轻和肥胖相关合并症的影响。
我们收集了 2013 年 8 月至 2016 年 3 月期间接受 ESG 的 91 例连续患者（平均年龄 43.86±11.26 岁；68%为女性）的数据。所有患者的体重指数（BMI）均大于 30kg/m²，且已尝试过非侵入性减肥措施，或 BMI 大于 40kg/m²，不适合手术或拒绝手术。所有手术均采用基于帽的灵活内镜缝合系统进行，以促进胃大弯的三角形缝合模式。术后 6 个月（n=73）、12 个月（n=53）和 24 个月（n=12）对患者进行人体测量特征（BMI、体重、腰围、血压）评估，并进行血清学（糖化血红蛋白 A1c）、血脂谱、血清甘油三酯和肝功能检查。主要结局为术后 6、12 和 24 个月的总体体重减轻。次要结局为 ESG 对代谢因素（血压、糖尿病、高血脂、脂肪性肝炎）和安全性的影响。
患者术前平均 BMI 为 40.7±7.0kg/m²。ESG 后 6 个月（80%随访率）患者体重减轻了 14.4%，12 个月（76%随访率）时减轻了 17.6%，24 个月（66%随访率）时减轻了 20.9%。ESG 后 12 个月，患者的糖化血红蛋白 A1c（P=0.01）、收缩压（P=0.02）、腰围（P<0.001）、丙氨酸氨基转移酶（P<0.001）和血清甘油三酯（P=0.02）水平均有统计学显著降低。然而，ESG 前后低密度脂蛋白无显著变化（P=0.79）。有 1 例严重不良事件（1.1%）（胃周漏），经非手术治疗。
ESG 是一种微创有效的内镜减重干预措施。除了持续 24 个月的总体体重减轻外，ESG 还降低了高血压、糖尿病和高甘油三酯血症的标志物。
