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Endoscopy 2021; 53(07): 727-731
DOI: 10.1055/a-1236-9347
Innovations and brief communications

Endoscopic sleeve gastroplasty: suturing the gastric fundus does not confer benefit

Jad Farha
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Christopher McGowan
2   True You Weight Loss, Cary, North Carolina, USA
,
Abdellah Hedjoudje
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Mohamad I. Itani
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Shahem Abbarh
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Cem Simsek
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Yervant Ichkhanian
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Trish Vulpis
3   WakeMed Cary Hospital, Cary, North Carolina, USA
,
Theodore W. James
4   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
,
Lea Fayad
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Mouen A. Khashab
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Andreas Oberbach
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Dilhana Badurdeen
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Vivek Kumbhari
1   Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Author commentary on Jad Farha et al.Endoscopy 2021; 53(07): v34-v34
DOI: 10.1055/a-1254-0643

Abstract

Background There is heterogeneity regarding the technical aspects of endoscopic sleeve gastroplasty (ESG), such as applying fundal sutures. Our aim was to determine whether ESG with fundal suturing (ESG-FS) affects weight loss and the serious adverse event (SAE) rate when compared with ESG with no fundal suturing (ESG-NFS).

Methods We conducted a two-center retrospective analysis of 247 patients who underwent ESG with or without fundal suturing. The primary outcome was percentage excess weight loss (%EWL) at 3, 6, and 12 months post-ESG. The secondary outcomes included the SAE rate and procedure duration.

Results At 3, 6, and 12-months, ESG-NFS had a significantly greater mean %EWL compared with ESG-FS (38.4 % [standard deviation (SD) 15.3 %] vs. 31.2 % [SD 13.9 %], P = 0.001; 54.7 % [SD 19.2 %] vs. 37.7 % [SD 17.3 %], P < 0.001; 65.3 % [SD 21.1 %] vs. 40.6 % [SD 23.5 %], P < 0.001, respectively). There was no statistically significant difference in the SAE rates for ESG-NFS (n = 2; 2.0 %) and ESG-FS (n = 4; 2.6 %; P > 0.99). The mean procedure time was significantly shorter in the ESG-NFS group at 59.1 minutes (SD 32.7) vs. 93.0 minutes (35.5; P < 0.001), and a lower mean number of sutures were used, with 5.7 (SD 1.1) vs. 8.4 (SD 1.6; P < 0.001).

Conclusion ESG-NFS demonstrated greater efficacy and shorter procedure duration. Therefore, fundal suturing should not be performed.

Supplementary material



Publication History

Received: 10 April 2020

Accepted: 10 August 2020

Accepted Manuscript online:
10 August 2020

Article published online:
08 October 2020

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  • References

  • 1 Gomez V. Making a U-turn at the stomach. Gastrointest Endosc 2019; 90: 781-783
    CrossrefPubMedGoogle Scholar
  • 2 Abu Dayyeh BK, Acosta A, Camilleri M. et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol 2017; 15: 37-43.e31
    CrossrefPubMedGoogle Scholar
  • 3 Hedjoudje A, Dayyeh BA, Cheskin LJ. et al. Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2020; 18: 1043-1053.e4
    CrossrefPubMedGoogle Scholar
  • 4 James TW, Reddy S, Vulpis T. et al. Endoscopic sleeve gastroplasty is feasible, safe, and effective in a non-academic setting: short-term outcomes from a community gastroenterology practice. Obes Surg 2020; 30: 1404-1409
    CrossrefPubMedGoogle Scholar
  • 5 Cheskin LJ, Hill C, Adam A. et al. Endoscopic sleeve gastroplasty versus high-intensity diet and lifestyle therapy: a case-matched study. Gastrointest Endosc 2020; 91: 342-349.e1
    CrossrefPubMedGoogle Scholar
  • 6 Fayad L, Adam A, Schweitzer M. et al. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc 2019; 89: 782-788
    CrossrefPubMedGoogle Scholar
  • 7 Fayad L, Cheskin LJ, Adam A. et al. Endoscopic sleeve gastroplasty versus intragastric balloon insertion: efficacy, durability, and safety. Endoscopy 2019; 51: 532-539
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Sartoretto A, Sui Z, Hill C. et al. Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study. Obes Surg 2018; 28: 1812-1821
    CrossrefPubMedGoogle Scholar
  • 9 Kumar N, Dayyeh BKA, Breviere GL-N. et al. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique. Surg Endosc 2018; 32: 2159-2164
    CrossrefPubMedGoogle Scholar
  • 10 Novikov AA, Afaneh C, Saumoy M. et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: how do they compare?. J Gastrointest Surg 2018; 22: 267-273
    CrossrefPubMedGoogle Scholar
  • 11 Langer F, Hoda MR, Bohdjalian A. et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005; 15: 1024-1029
    CrossrefPubMedGoogle Scholar
  • 12 Lopez-Nava G, Negi A, Bautista-Castaño I. et al. Gut and metabolic hormones changes after endoscopic sleeve gastroplasty (ESG) vs. laparoscopic sleeve gastrectomy (LSG). Obes Surg 2020; 30: 2642-2651
    CrossrefPubMedGoogle Scholar
  • 13 Ginsberg GG, Chand B, Cote GA. et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc 2011; 74: 943-953
    CrossrefPubMedGoogle Scholar
  • 14 Abu Dayyeh BK, Kumar N. ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee. et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc 2015; 82: 425-438
    CrossrefPubMedGoogle Scholar
  • 15 Elariny H, Gonzalez H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int 2005; 14: 119-124
    PubMedGoogle Scholar
  • 16 James TW, McGowan CE. The descending gastric fundus in endoscopic sleeve gastroplasty: implications for procedural technique and adverse events. VideoGIE 2019; 4: 254-255
    CrossrefPubMedGoogle Scholar
  • 17 James TW, Sheikh SZ, McGowan CE. Perigastric abscess as a delayed adverse event in endoscopic sleeve gastroplasty. Gastrointest Endosc 2019; 89: 890-891
    CrossrefPubMedGoogle Scholar
  • 18 Hill C, El Zein M, Agnihotri A. et al. Endoscopic sleeve gastroplasty: the learning curve. Endosc Int Open 2017; 5: E900-E904
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Saumoy M, Schneider Y, Zhou XK. et al. A single-operator learning curve analysis for the endoscopic sleeve gastroplasty. Gastrointest Endosc 2018; 87: 442-447
    CrossrefPubMedGoogle Scholar