Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain.
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
Surg Endosc. 2021 Jun;35(6):2523-2530. doi: 10.1007/s00464-020-07666-6. Epub 2020 Jun 24.
Although primary endoscopic sleeve gastroplasty (P-ESG) is effective, some patients may require revision procedures to augment weight loss. We hypothesized that a non-surgical approach using redo ESG (R-ESG) might be a viable option in such patients. We aimed to assess the safety and efficacy of R-ESG following P-ESG to treat obesity.
We reviewed the outcome of patients who underwent R-ESG at our unit. We classified them as weight loss failure (WF)-< 10% total body weight (TBWL) at 6-months; weight regain (WR)-lost ≥ 10% TBWL and regained 50% of the maximum weight loss at or after 1-year; weight plateau (WP)-lost ≥ 10% TBWL but could not lose further over 3-months. We analyzed the feasibility, safety, and evaluated the efficacy of R-ESG in each group.
Of the 482 patients who underwent P-ESG, 35 (7%) required R- ESG (WF-12, WR-12, WP-11). The mean age, weight, BMI (38.2 kg/m), and the number of sutures used during P-ESG were similar between the groups. The nadir %TBWL was lowest in WF group compared to WR and WP (6.5% vs. 20% vs. 22.4%, p = 0.001). The mean BMI at R-ESG was 33.6 kg/m. The time to R-ESG was longer in the WR group compared to WF and WP (22.3 vs. 13.4 vs. 13.7 months, p = 0.03). We placed a median of 3 (range 2-6) sutures. R-ESG was technically successful, and no serious complications occurred. All except two patients were discharged on the same day. The overall %TBWL achieved by R-ESG was significantly higher in WP (26%) as compared to WF (11.2%) and WR (12%), respectively (p = 0.001).
The need for R-ESG after P-ESG is low. R-ESG is safe and induced weight loss in all patients. The maximum benefit was observed in WP.
尽管原发性内镜袖套胃成形术（P-ESG）有效，但一些患者可能需要进行修正手术以增强减重效果。我们假设，在这些患者中，使用重复 ESG（R-ESG）的非手术方法可能是一种可行的选择。我们旨在评估 R-ESG 在 P-ESG 治疗肥胖症后的安全性和疗效。
我们回顾了在我们单位接受 R-ESG 的患者的结果。我们将他们分为体重减轻失败（WF）组-6 个月时体重减轻<10%总体重（TBWL）；体重反弹（WR）组-丢失≥10%TBWL 并在 1 年或之后恢复 50%的最大减重；体重平台期（WP）组-丢失≥10%TBWL，但在 3 个月内无法进一步减轻体重。我们分析了 R-ESG 在每组中的可行性、安全性和疗效。
在接受 P-ESG 的 482 名患者中，有 35 名（7%）需要进行 R-ESG（WF-12、WR-12、WP-11）。WF 组、WR 组和 WP 组之间的平均年龄、体重、BMI（38.2kg/m）和 P-ESG 期间使用的缝线数量相似。最低的体重减轻百分比（%TBWL）在 WF 组中最低，与 WR 和 WP 组相比（6.5%比 20%比 22.4%，p=0.001）。R-ESG 时的平均 BMI 为 33.6kg/m。WR 组的 R-ESG 时间较 WF 组和 WP 组长（22.3 比 13.4 比 13.7 个月，p=0.03）。我们放置了中位数为 3 个（范围 2-6 个）缝线。R-ESG 技术上是成功的，没有发生严重并发症。除了两名患者外，所有患者均在同一天出院。与 WF 组（11.2%）和 WR 组（12%）相比，WP 组（26%）的 R-ESG 总体重减轻百分比明显更高（p=0.001）。
在 P-ESG 后需要进行 R-ESG 的情况很少。R-ESG 是安全的，并使所有患者的体重减轻。WP 组观察到最大的益处。
