1St Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Chirurgia Generale 1, sesto piano Policlinico, Azienda Ospedale-Università Padova University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
Bariatric Unit, Week Surgery, Padova University Hospital, University of Padova, Padua, Italy.
Updates Surg. 2022 Dec;74(6):1971-1975. doi: 10.1007/s13304-022-01385-4. Epub 2022 Sep 27.
The aim of this study was to evaluate the safety and efficacy of the endoscopic sleeve gastroplasty (ESG) procedure. Patients ineligible for bariatric surgery due to comorbidities or low Body Mass Index (BMI) were offered ESG. Gastric tubularization was carried out via multiple multi-bite sutures across the greater curvature of the stomach. The patients underwent a water-soluble swallow test on post-operative day 1 (POD-1) to assess gastric emptying and were placed on a soft diet if upper GI tract function was confirmed. From January 2019 to March 2022, 27 patients underwent ESG: 14 for severe obesity with comorbidities, including liver transplant, end-stage kidney disease, severe cardiovascular and respiratory diseases. The mean BMI before treatment was 36 ± 9 kg/m. Two patients (7%) who developed gastric bleeding were successfully treated with packed red blood cells (PRBC) transfusions. After a mean follow-up of 18 months, the percentage of total body weight loss (%TBWL) and the percentage of excess weight (%EWL) were 11 ± 7 and 39 ± 27, respectively. The latter was significantly higher in the patients with an initial BMI < 40 kg/m (50 vs 22, p < 0.05). The patients whose gastric sleeve extended for more than a third of the length of the stomach (p < 0.05) had better results. ESG was found to be effective and safe in high-risk surgical patients whose initial BMI was (< 40). Studies characterized by larger number of patients and longer follow-up periods will be able to confirm these results.
本研究旨在评估内镜袖状胃成形术（ESG）的安全性和有效性。由于合并症或低体重指数（BMI）而不适合接受减重手术的患者被提供 ESG。通过在胃大弯处进行多次多口缝合来实现胃管化。患者在术后第 1 天（POD-1）进行水溶性吞咽试验，以评估胃排空情况，如果确认上消化道功能正常，则给予软食。从 2019 年 1 月至 2022 年 3 月，共 27 例患者接受了 ESG：14 例为伴有合并症的严重肥胖患者，包括肝移植、终末期肾病、严重心血管和呼吸系统疾病。治疗前平均 BMI 为 36±9kg/m。有 2 例（7%）发生胃出血的患者经红细胞悬液（PRBC）输注成功治疗。平均随访 18 个月后，总体重减轻百分比（%TBWL）和多余体重减轻百分比（%EWL）分别为 11±7%和 39±27%。初始 BMI<40kg/m 的患者的后者明显更高（50 比 22，p<0.05）。胃袖套延伸超过胃长度三分之一的患者（p<0.05）结果更好。对于初始 BMI<（40 的高风险手术患者，ESG 被发现是有效且安全的。具有更大患者数量和更长随访期的研究将能够证实这些结果。
