Maselli Daniel Barry, Hoff Anna Carolina, Kucera Ashley, Weaver Emily, Sebring Laura, Gooch Lori, Walton Kathleen, Lee Daniel, Cratty Taylor, Beal Selena, Nanduri Srikar, Rease Kendall, Gainey Christina S, Eaton Laura, Coan Brian, McGowan Christopher E
Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States.
Bariatric Endoscopy, Angioskope Clinic, São José dos Campos 12243-680, São Paulo, Brazil.
World J Gastrointest Endosc. 2023 Jun 16;15(6):469-479. doi: 10.4253/wjge.v15.i6.469.
Endoscopic sleeve gastroplasty (ESG) is an effective therapy for class I-II obesity, but there are knowledge gaps in the published literature about its implementation in patients with class III obesity [body mass index (BMI) ≥ 40 kg/m].
To evaluate the safety, clinical efficacy, and durability of ESG in adults with class III obesity.
This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss (TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss (EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.
404 consecutive patients (78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type II diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization (0.2% serious adverse event rate).
When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class III obesity, with improvement in comorbidities and an acceptable safety profile.
内镜下袖状胃成形术（ESG）是治疗I-II级肥胖的有效方法，但已发表的文献中关于其在III级肥胖患者（体重指数（BMI）≥40kg/m²）中的应用存在知识空白。
评估ESG在III级肥胖成人中的安全性、临床疗效和持久性。
这是一项回顾性队列研究，使用了前瞻性收集的2018年5月至2022年3月在两个具备内镜减重治疗专业知识的中心接受ESG及纵向生活方式咨询的BMI≥40kg/m²成人患者的数据。主要结局是12个月时的总体重减轻（TBWL）。次要结局包括至36个月各时间点的TBWL、超重减轻（EWL）和BMI变化、12个月和24个月时的临床缓解率以及合并症改善情况。通过整个研究期间报告安全性结局。对研究期间的TBWL、EWL和BMI进行单因素方差分析及多次Tukey两两比较。
连续纳入404例患者（78.5%为女性，平均年龄42.9岁，平均BMI 44.8±4.7kg/m²）。ESG平均使用7针缝线，手术时间42±9分钟，技术成功率100%。12个月时TBWL为20.9±6.2%，24个月时为20.5±6.9%，36个月时为20.3±9.5%。ESG术后12、15、24和36个月时的TBWL无差异。12个月时，分别有96.7%、87.4%和55.6%的队列患者TBWL超过10%、15%和20%。在ESG时患有相关合并症的队列中，研究期间66.1%的高血压患者病情改善，61.7%的II型糖尿病患者病情改善，45.1%的高脂血症患者病情改善。有1例脱水需要住院治疗（严重不良事件发生率0.2%）。
当与纵向营养支持相结合时，ESG可使III级肥胖成人有效且持久地减重，合并症得到改善，安全性可接受。
