Patients who underwent the endoscopic sleeve gastroplasty (ESG) suffered fewer post-procedural adverse events than patients who underwent the more commonly performed surgical laparoscopic sleeve gastrectomy (LSG). Both are bariatric procedures that aim to achieve weight loss by reducing the volume of the stomach by approximately 70 percent and restricting the amount of food a person can eat. The LSG, currently the most commonly performed bariatric procedure, achieves this by excising a significant portion of the stomach surgically. Conversely, the more novel ESG reduces the stomach from the inside using endoscopic suturing.
A research team led by Johns Hopkins Medicine gastroenterologist Vivek Kumbhari, M.D., compared these two procedures and found that while patients who received the laparoscopic sleeve lost more weight after six months, the endoscopic sleeve patients had a significantly lower chance of developing gastroesophageal reflux disease (GERD) and other post-procedural adverse events than did the patients from the laparoscopic sleeve group. The results of this study were published in the journal of Gastrointestinal Endoscopy (GIE).
The researchers examined data from 54 patients who received the endoscopic sleeve and 83 patients who underwent laparoscopic sleeve up to six months following their respective procedures. These patients were similar with regards to age, gender and BMI prior to undergoing their respective interventions. All patients who underwent the endoscopic sleeve had their procedures performed as a day case without the need for an overnight stay.
Conversely, patients who underwent the laparoscopic sleeve, all required at least one overnight stay in hospital. The more minimally invasive endoscopic sleeve likely resulted in less disruption to the patient’s life and a rapid return to work related activities.
While the laparoscopic sleeve patients had greater weight loss (23 percent vs. 18 percent), the endoscopic sleeve patients had a significantly lower rate of adverse events (5.2 percent vs. 16.9 percent). There were no adverse events among the endoscopic group while hospitalized although three discharged patients experienced symptoms that required readmission.
Among the laparoscopic patient group, four patients experienced adverse events during hospitalization and eight required readmission due to adverse events including dehydration, pain, nausea and vomiting, in addition to acute pancreatitis. Furthermore, new onset GERD was also less common in the endoscopic patient group (1.9 percent vs. 14.5 percent).
“Bariatric surgery is elective, so patients may choose to opt for the endoscopic procedure with fewer potential side effects even if the weight lost, up to six months, may be less than the more conventional approach,” says Kumbhari. “Endoscopic Sleeve Gastroplasty may prove to be a good option for a larger population of patients because it’s less invasive, lower risk and may be more cost-effective.” Kumbhari cautions, however, that additional research with longer-term outcomes is necessary to determine which approach is best for different types of patients.
Dr. Kumbhari is the director of bariatric endoscopy at Johns Hopkins Medicine, and currently practices at Sibley Memorial Hospital in Washington and Johns Hopkins Hospital in East Baltimore.
For more information about the Sibley Weight Loss Center, please visit http://www.sibleyweightloss.com/.