By Kathleen Doheny
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The procedure, called endoscopic sleeve gastroplasty, or ESG, cinches a patient's stomach to make it smaller. Doctors use an endoscope -- a tube with a light and camera attached to it -- to perform the treatment.
In a study presented at the Digestive Disease Week conference, researchers looked at how the emerging treatment compared with two types of weight loss surgery.
The sleeve procedure "cinches [the stomach] to one-third of the original size, and it sort of looks like a sleeve," says Reem Z. Sharaiha, MD, assistant professor of medicine at Weill Cornell Medicine, who led the study.
She says the procedure makes the stomach shorter and narrower. As a result, patients eat much less food. And because the stomach's smaller, the food stays in it longer, and it takes longer to go down.
As with surgery, endoscopic sleeve gastroplasty is only for someone who is obese -- with a body mass index (BMI) over 30. Although bariatric surgery has helped many people lose weight, a 2013 study found that only about 1% of eligible patients have the procedure due to risks, limited access, costs, or their preference.
Experts say the new treatment could give some people an alternative.
How the New Procedure Stacks Up
Sharaiha is a consultant for Apollo, which makes the suturing device used in the treatment. The findings she presented at the meeting have not been peer-reviewed.
She followed 278 obese men and women for a year after they had one of three procedures. Of those:
- 91 had endoscopic sleeve gastroplasty
- 120 had a laparoscopic sleeve gastrectomy, which removes about 75% of the stomach. It requires a surgeon to make several small cuts.
- 67 had a laparoscopic banding, which places a band around a patient's stomach to restrict eating.
The patients who tried the endoscopic sleeve gastroplasty had the lowest BMI of the three groups. Theirs was 39, compared with an average BMI of 46 and 47 for the sleeve gastrectomy and lap band surgery groups. On average, the patients were in their 40s for all groups. At one year, the weight loss was:
- 29% for laparoscopic sleeve gastrectomy
- 18% for the endoscopic sleeve gastroplasty
- 14% for laparoscopic band surgery
Although the treatment didn't bring the most weight loss, Sharaiha says it has a much lower complication rate and cost than standard bariatric procedures for weight loss.
Patients using the endoscopic treatment had complication rates of 1%, compared with 10% for laparoscopic sleeve gastrectomy and 11% for laparoscopic banding. "The main side effect [of ESG] is nausea and vomiting and cramping that lasts 24 to 48 hours,'' she says.
One patient had food leak outside the stomach. Infection is a risk, she says, as are stomach ruptures and bleeding. Patients are advised take it easy for a few days, usually returning to work after that. They are on a liquid diet for 2 weeks, then they eat soft food and gradually introduce a regular diet.
Sharaiha says about one of five procedures are reimbursed by insurance. The average cost in the study was $12,000 for the endoscopic procedure, compared with $15,000 for lap band surgery and $22,000 for laparoscopic sleeve surgery.
About 500 of the endoscopic procedures have been done in the U.S., she estimates. The FDA approved the device used in the treatment in 2008.
The new procedure won't replace other weight loss approaches but is an option for those who can't have surgery or who would prefer not to, she says. It takes about 45 minutes and requires general anesthesia. It's an outpatient procedure.
"This is for someone with a BMI of 30 to 40 who is motivated enough, who knows it is not the magic pill to lose weight," she says. The procedure is done with the understanding that the patient will also exercise regularly and eat a healthy diet.
Ken Fujioka, MD, an endocrinologist and director of the Center for Weight Management, Scripps Clinic, San Diego, agrees the new treatment is not meant to replace other procedures, but will widen choices for obese patients. He called the amount of weight loss it achieved ''exciting'' and said it appears to have lower risk.
"I think the findings are important," says Richard Lindquist, MD, an obesity medicine specialist at Swedish Medical Center, Seattle. Cost effectiveness and results both look good, he says.
Lindquist and Fujioka say they would like to know whether the new procedure affects hunger-related hormones the way some other procedures do. Gastrectomy, for instance, removes many of the stomach cells that produce the ''hunger hormone," ghrelin.
Sharaiha says one study of the new treatment did show that it reduced ghrelin levels, but only four patients were involved. More study is needed, she says.
Lindquist consults for Novo Nordisk and Orexigen, which makes the weight loss drug Contrave (naltrexone/bupropion).
Digestive Disease Week presentation, May 6, 2017, Chicago. Reem Z. Sharaiha, MD, assistant professor of medicine, Weill Cornell Medicine; attending physician, New York-Presbyterian/Weill Cornell Medical Center, New York. Ken Fujioka, MD, director, Center for Weight Management, Scripps Clinic, Department of Endocrinology, San Diego. Richard Lindquist, MD, obesity medicine specialist, Swedish Medical Center, Seattle; former member, board of directors, Obesity Medicine Association. Clinical Gastroenterology and Hepatology: "Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients."
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