Pelizzo Gloria, Destro Francesca, Perretta Silvana, Paraboschi Irene, Zappa Marco Antonio, Pierucci Ugo Maria
Department of Pediatric Surgery, Buzzi Children's Hospital, Milan, Italy.
Department of Biomedical and Clinical Science, University of Milano, Milan, Italy.
Obes Surg. 2025 Aug 13. doi: 10.1007/s11695-025-08139-2.
Adolescent obesity is a growing global health concern, often refractory to conventional interventions. While bariatric surgery remains the most effective treatment, its invasiveness and long-term implications limit its use in pediatric patients. Endoscopic sleeve gastroplasty (ESG) has recently emerged as a minimally invasive alternative. This narrative review aims to provide a comprehensive overview of ESG in adolescents, addressing efficacy, safety, mechanisms of action, comparisons with other therapies, and current guideline recommendations. We conducted a narrative review of studies on ESG in individuals under 21 years of age. Literature searches were performed using PubMed, Scopus, EMBASE, and Web of Science for English-language articles published up to April 2025. Studies were included if they reported on ESG outcomes, safety, mechanisms, indications, or expert consensus. Available pediatric data, primarily from a single-center cohort of 109 adolescents, show a total body weight loss (TBWL) of 14.4% at 6 months, 16.2% at 12 months, and 13.7% at 24 months. ESG demonstrated a favorable safety profile, with minor adverse events (abdominal pain, nausea) in 2-3% and no severe complications or growth impairment. Mechanistically, ESG induces weight loss via gastric restriction and delayed gastric emptying, without altering nutrient absorption or appetite-regulating hormones. Comparisons with other modalities show ESG outperforms lifestyle therapy and pharmacotherapy in TBWL, with fewer complications than laparoscopic sleeve gastrectomy. ESG is cost-effective in class II obesity and may be reversible or combined with medical therapies. Despite promising results, ESG remains supported by Level IV evidence and is recognized in only a few pediatric guidelines. ESG offers a safe, anatomy-preserving, and moderately effective treatment option for adolescents with moderate-to-severe obesity. It may serve as a valuable bridge between conservative therapy and surgery. However, long-term data and randomized controlled trials are needed to define its role within standardized pediatric obesity care pathways.
青少年肥胖是一个日益严重的全球健康问题，通常对传统干预措施具有抗性。虽然减肥手术仍然是最有效的治疗方法，但其侵入性和长期影响限制了其在儿科患者中的应用。内镜下袖状胃成形术（ESG）最近已成为一种微创替代方法。本叙述性综述旨在全面概述青少年ESG，涉及疗效、安全性、作用机制、与其他疗法的比较以及当前指南建议。我们对21岁以下个体的ESG研究进行了叙述性综述。使用PubMed、Scopus、EMBASE和Web of Science对截至2025年4月发表的英文文章进行了文献检索。如果研究报告了ESG结果、安全性、机制、适应症或专家共识，则将其纳入。现有的儿科数据主要来自一个包含109名青少年的单中心队列，显示6个月时总体重减轻（TBWL）为14.4%，12个月时为16.2%，24个月时为13.7%。ESG显示出良好的安全性，2-3%的患者出现轻微不良事件（腹痛、恶心），无严重并发症或生长障碍。从机制上讲，ESG通过胃限制和延迟胃排空诱导体重减轻，而不改变营养吸收或食欲调节激素。与其他方式的比较表明，ESG在TBWL方面优于生活方式疗法和药物疗法，并发症比腹腔镜袖状胃切除术少。ESG在II级肥胖中具有成本效益，可能是可逆的或可与药物疗法联合使用。尽管结果令人鼓舞，但ESG仍然仅得到IV级证据的支持，并且仅在少数儿科指南中得到认可。ESG为中重度肥胖青少年提供了一种安全、保留解剖结构且中等有效的治疗选择。它可能成为保守治疗和手术之间的重要桥梁。然而，需要长期数据和随机对照试验来确定其在标准化儿科肥胖护理路径中的作用。
