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Endoscopic sleeve gastroplasty achieves significantly greater weight loss than that of a high-intensity diet and lifestyle therapy program, according to a study published in Gastrointestinal Endoscopy.
In the retrospective case-matched study, 105 patients who underwent endoscopic sleeve gastroplasty, in combination with a low-intensity diet and lifestyle therapy, were compared with 281 patients who participated in a high-intensity diet and lifestyle therapy program.
“As ESG [endoscopic sleeve gastroplasty] continues to gain traction worldwide, a comprehensive understanding of its outcomes and relative place among the battery of weight loss treatments is important,” wrote Lawrence J. Cheskin, MD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, and coauthors, noting that only two studies have compared endoscopic sleeve gastroscopy with another weight loss therapy.
The high-intensity program involved patients being prescribed a low-calorie, high-protein diet of 800-1,200 calories a day, and taking part in behavioral, nutritional, and exercise counseling as well as optional support from psychotherapy, support groups, and meal replacements.
The study found that patients who underwent the gastroplasty lost significantly greater mean percentage of body weight compared with those who participated in the therapy program.
At 1 month, mean percentage body weight loss was 9.3% in the gastroplasty group compared with 7% in the therapy group. At 3 months it was 14% compared with 11.3%, at 6 months it was 17.7% compared with 14.7%, and at 12 months it was 20.6% compared with 14.3%. Significantly more patients in the gastroplasty group reached 5%, 10%, and 20% weight loss compared with the therapy group.
The authors noted that high-intensity diet and lifestyle therapy programs had “notoriously” high rates of noncompliance and withdrawal from treatment; adherence rates of 63.1% and 59.6% had been seen in previous observational studies.
“Therefore, ESG may be a valuable alternative for patients who have had trouble adhering to HIDLT [high-intensity diet and lifestyle therapy],” they wrote. “Given the diversity of the obese population, ESG may begin to fill some gaps in the obesity treatment arsenal.”
A subgroup analysis looked at patients with a baseline body mass index below or above 40 kg/m2, and found even after adjustment for age and sex, both groups showed significantly more weight loss at 1 and 3 months for patients who underwent gastroplasty. However, at 6 and 12 months, the study saw no significant difference between gastroplasty and the therapy program for patients with a baseline BMI above 40 kg/m2.
While the cause of this difference in effect in higher BMI patients was unknown, it may be that sleeve gastroplasty is less effective because it is counteracted by neurohormonal effects that are altered with bariatric surgery, the authors wrote.
“This is worth exploring in future randomized control trials because it will give us insight into which patients are superior candidates for endoscopic bariatric therapy,” they wrote.
There were five moderate to severe adverse events in the gastroplasty cohort and none in the therapy group. There were three cases of upper gastrointestinal bleeding caused by gastric ulceration. In one case, the patient underwent diagnostic endoscopy, admission, and 48-hour monitoring. Another patient developed perigastric fluid collection, and one was admitted for intravenous hydration after experiencing dehydration. Despite this, the authors suggested the adverse event rate associated with the procedure may be acceptable to patients because of the superior weight loss effect compared with therapy programs.
No funding was declared. Three authors declared consultancies, advisory board positions, and personal fees from medical device companies including those in the endoscopy space. No other conflicts of interest were declared.
SOURCE: Cheskin L et al. Gastrointest Endosc. 2019 Sep 27. doi: 10.1016/j.gie.2019.09.029.
Endoscopic sleeve gastroplasty achieves significantly greater weight loss than that of a high-intensity diet and lifestyle therapy program, according to a study published in Gastrointestinal Endoscopy.
In the retrospective case-matched study, 105 patients who underwent endoscopic sleeve gastroplasty, in combination with a low-intensity diet and lifestyle therapy, were compared with 281 patients who participated in a high-intensity diet and lifestyle therapy program.
“As ESG [endoscopic sleeve gastroplasty] continues to gain traction worldwide, a comprehensive understanding of its outcomes and relative place among the battery of weight loss treatments is important,” wrote Lawrence J. Cheskin, MD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, and coauthors, noting that only two studies have compared endoscopic sleeve gastroscopy with another weight loss therapy.
The high-intensity program involved patients being prescribed a low-calorie, high-protein diet of 800-1,200 calories a day, and taking part in behavioral, nutritional, and exercise counseling as well as optional support from psychotherapy, support groups, and meal replacements.
The study found that patients who underwent the gastroplasty lost significantly greater mean percentage of body weight compared with those who participated in the therapy program.
At 1 month, mean percentage body weight loss was 9.3% in the gastroplasty group compared with 7% in the therapy group. At 3 months it was 14% compared with 11.3%, at 6 months it was 17.7% compared with 14.7%, and at 12 months it was 20.6% compared with 14.3%. Significantly more patients in the gastroplasty group reached 5%, 10%, and 20% weight loss compared with the therapy group.
The authors noted that high-intensity diet and lifestyle therapy programs had “notoriously” high rates of noncompliance and withdrawal from treatment; adherence rates of 63.1% and 59.6% had been seen in previous observational studies.
“Therefore, ESG may be a valuable alternative for patients who have had trouble adhering to HIDLT [high-intensity diet and lifestyle therapy],” they wrote. “Given the diversity of the obese population, ESG may begin to fill some gaps in the obesity treatment arsenal.”
A subgroup analysis looked at patients with a baseline body mass index below or above 40 kg/m2, and found even after adjustment for age and sex, both groups showed significantly more weight loss at 1 and 3 months for patients who underwent gastroplasty. However, at 6 and 12 months, the study saw no significant difference between gastroplasty and the therapy program for patients with a baseline BMI above 40 kg/m2.
While the cause of this difference in effect in higher BMI patients was unknown, it may be that sleeve gastroplasty is less effective because it is counteracted by neurohormonal effects that are altered with bariatric surgery, the authors wrote.
“This is worth exploring in future randomized control trials because it will give us insight into which patients are superior candidates for endoscopic bariatric therapy,” they wrote.
There were five moderate to severe adverse events in the gastroplasty cohort and none in the therapy group. There were three cases of upper gastrointestinal bleeding caused by gastric ulceration. In one case, the patient underwent diagnostic endoscopy, admission, and 48-hour monitoring. Another patient developed perigastric fluid collection, and one was admitted for intravenous hydration after experiencing dehydration. Despite this, the authors suggested the adverse event rate associated with the procedure may be acceptable to patients because of the superior weight loss effect compared with therapy programs.
No funding was declared. Three authors declared consultancies, advisory board positions, and personal fees from medical device companies including those in the endoscopy space. No other conflicts of interest were declared.
SOURCE: Cheskin L et al. Gastrointest Endosc. 2019 Sep 27. doi: 10.1016/j.gie.2019.09.029.
Endoscopic sleeve gastroplasty achieves significantly greater weight loss than that of a high-intensity diet and lifestyle therapy program, according to a study published in Gastrointestinal Endoscopy.
In the retrospective case-matched study, 105 patients who underwent endoscopic sleeve gastroplasty, in combination with a low-intensity diet and lifestyle therapy, were compared with 281 patients who participated in a high-intensity diet and lifestyle therapy program.
“As ESG [endoscopic sleeve gastroplasty] continues to gain traction worldwide, a comprehensive understanding of its outcomes and relative place among the battery of weight loss treatments is important,” wrote Lawrence J. Cheskin, MD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, and coauthors, noting that only two studies have compared endoscopic sleeve gastroscopy with another weight loss therapy.
The high-intensity program involved patients being prescribed a low-calorie, high-protein diet of 800-1,200 calories a day, and taking part in behavioral, nutritional, and exercise counseling as well as optional support from psychotherapy, support groups, and meal replacements.
The study found that patients who underwent the gastroplasty lost significantly greater mean percentage of body weight compared with those who participated in the therapy program.
At 1 month, mean percentage body weight loss was 9.3% in the gastroplasty group compared with 7% in the therapy group. At 3 months it was 14% compared with 11.3%, at 6 months it was 17.7% compared with 14.7%, and at 12 months it was 20.6% compared with 14.3%. Significantly more patients in the gastroplasty group reached 5%, 10%, and 20% weight loss compared with the therapy group.
The authors noted that high-intensity diet and lifestyle therapy programs had “notoriously” high rates of noncompliance and withdrawal from treatment; adherence rates of 63.1% and 59.6% had been seen in previous observational studies.
“Therefore, ESG may be a valuable alternative for patients who have had trouble adhering to HIDLT [high-intensity diet and lifestyle therapy],” they wrote. “Given the diversity of the obese population, ESG may begin to fill some gaps in the obesity treatment arsenal.”
A subgroup analysis looked at patients with a baseline body mass index below or above 40 kg/m2, and found even after adjustment for age and sex, both groups showed significantly more weight loss at 1 and 3 months for patients who underwent gastroplasty. However, at 6 and 12 months, the study saw no significant difference between gastroplasty and the therapy program for patients with a baseline BMI above 40 kg/m2.
While the cause of this difference in effect in higher BMI patients was unknown, it may be that sleeve gastroplasty is less effective because it is counteracted by neurohormonal effects that are altered with bariatric surgery, the authors wrote.
“This is worth exploring in future randomized control trials because it will give us insight into which patients are superior candidates for endoscopic bariatric therapy,” they wrote.
There were five moderate to severe adverse events in the gastroplasty cohort and none in the therapy group. There were three cases of upper gastrointestinal bleeding caused by gastric ulceration. In one case, the patient underwent diagnostic endoscopy, admission, and 48-hour monitoring. Another patient developed perigastric fluid collection, and one was admitted for intravenous hydration after experiencing dehydration. Despite this, the authors suggested the adverse event rate associated with the procedure may be acceptable to patients because of the superior weight loss effect compared with therapy programs.
No funding was declared. Three authors declared consultancies, advisory board positions, and personal fees from medical device companies including those in the endoscopy space. No other conflicts of interest were declared.
SOURCE: Cheskin L et al. Gastrointest Endosc. 2019 Sep 27. doi: 10.1016/j.gie.2019.09.029.
FROM GASTROINTESTINAL ENDOSCOPY