内镜袖状胃成形术（ESG）治疗肥胖术后再次缝合。

Re-suturing after primary endoscopic sleeve gastroplasty (ESG) for obesity.

机构信息

Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain.

Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.

出版信息

Surg Endosc. 2021 Jun;35(6):2523-2530. doi: 10.1007/s00464-020-07666-6. Epub 2020 Jun 24.

DOI:10.1007/s00464-020-07666-6

PMID:32583068

Abstract

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

介绍

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。

方法

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。

结果

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）。