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ENDOSCOPIC SLEEVE GASTROPLASTY , LAPAROSCOPIC SLEEVE GASTRECTOMY, AND LAPAROSCOPIC BAND FOR WEIGHT LOSS, HOW DO THEY COMPARE ?
Aleksey A. Novikov*, Cheguevera Afaneh, Monica Saumoy, Alpana Shukla, Gregory Dakin, Alfons Pomp, Louis J. Aronne, Reem Z. Sharaiha
Weill Cornell Medical Center, New York, NY
Abstract: Endoscopic sleeve gastroplasty (ESG) utilizes an endoscopic suturing system to place full-thickness sutures through the greater curvature of the stomach and reduce gastric volume. ESG has gained popularity as a weight loss option for obese patients with a BMI >30 who refuse surgery or are poor surgical candidates. Initial studies demonstrated an association of ESG with weight loss and improvement of obesity related comorbidities. The aim was to evaluate comparative effectiveness of ESG compared to laparoscopic sleeve gastrectomy (LSG) and laparoscopic band (LAGB) placement with respect to peri-procedural morbidity, length of stay (LOS) and readmission rates.
Methods: Obese patients who underwent LSG, LAGB, or ESG between January 2012 and September 2016 and were followed at an academic bariatric center of excellence were included. Patient characteristics including age, gender, BMI, hemoglobin A1C, and presence of obesity-associated comorbidities were collected (Table). Percent total body weight loss (%TBWL) at 3, 6, 9, and 12 months was the primary outcome measure. Adverse events (AE), length of stay (LOS) and readmission rate were evaluated as secondary outcome measures.
Results: 278 patients were included: 91 patients underwent ESG, 120 underwent LSG, and 67 underwent LAGB. Patient characteristics such as age, gender, and presence of diabetes, were similar amongst the three groups (p>0.05). On average, patients who had LSG had higher BMI than LAGB, and patients who had ESG had lower BMI (47.3 vs 45.7 vs 38.8 kg/m2, p <0.01). Incidence of hypertension, and hyperlipidemia were also higher in the surgical groups compared to the ESG group (p<0.01) (Table). At 12 month follow-up, LSG achieved the greatest %TBWL compared to LAGB and ESG (29.28% vs 14.46% vs 17.57% respectively; p < 0.001) (Figure). However, ESG had a significantly lower rate of post-procedure morbidity when compared to LSG or LAGB (p<0.014). Post-procedure length of stay was also significantly less for ESG compared to LSG or LAGB (0.13 vs 3.09 vs. 1.68 days respectively; p<0.01). (Table). Institutional procedure costs also favor ESG (Table).
Conclusion: ESG is a safe and effective minimally invasive weight loss therapy. Although LSG achieved the greatest %TBWL, ESG was associated with lower morbidity and length of stay. ESG should be considered as an additional standalone option in the management of obesity.
Table. Treatment group baseline characteristics, outcome measures as well as our center procedure costs are depicted. Numbers represent mean values or percentages unless otherwise stated.
Figure. Treatment groups BMI and %TBWL ((baseline weight -weight at follow-up)/baseline weight)*100 ) are plotted at the origin, 3, 6, 9, and 12 months. Error bars reporesent standard deviation.
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