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Effects on physiologic measures of appetite from intragastric balloon and Endoscopic sleeve gastroplasty: results of a prospective study

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Chinese Medical Journal 2022年第10期135卷 1234-1241页

作者： Babusai Rapaka Daniel B.Maselli Gontrand Lopez-Nava Inmaculada Bautista-Castano Reem Matar Veeravich Jaruvongvanich Eric J.Vargas Andrew C.Storm Andres Acosta Barham K.Abu Dayyeh Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905USA Madrid Sanchinarro University Hospital MadridSpain

Background: endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods: We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent Endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results: The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mLvs. 183.00 ± 217.13 mL,P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion: IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

关键词： Intragastric balloon Endoscopic sleeve gastroplasty Gastric emptying Gastric accommodation Obesity

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Endoscopic sleeve gastroplasty in class Ⅲ obesity:Efficacy, safety, and durability outcomes in 404 consecutive patients

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World Journal of Gastrointestinal Endoscopy 2023年第6期15卷 469-479页

作者： Daniel Barry Maselli Anna Carolina Hoff Ashley Kucera Emily Weaver Laura Sebring Lori Gooch Kathleen Walton Daniel Lee Taylor Cratty Selena Beal Srikar Nanduri Kendall Rease Christina S Gainey Laura Eaton Brian Coan Christopher E McGowan Department of Endobariatrics True You Weight LossCaryNC 27513United States Bariatric Endoscopy Angioskope ClinicSão Josédos Campos 12243-680São PauloBrazil Gastroenterology and Hepatology University of North Carolina SystemChapel HillNC 27599United States UltaMed Corporation UltaMed CorporationFort LauderdaleFL 33308United States

BACKGROUND Endoscopic sleeve gastroplasty(ESG) is an effective therapy for class Ⅰ-Ⅱ obesity, but there are knowledge gaps in the published literature about its implementation in patients with class Ⅲ obesity [body mass index(BMI) ≥ 40 kg/m2].AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class Ⅲ obesity.METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss(TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss(EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.RESULTS 404 consecutive patients(78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type Ⅱ diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization(0.2% serious adverse event rate).CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class Ⅲ obesity, with improvement in comorbiditie

关键词： Endoscopic sleeve gastroplasty Obesity Bariatric Endobariatrics Class III obesity Comorbidities

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Advances in endobariatrics:past,present,and future

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Gastroenterology Report 2023年第1期11卷 140-150页

作者： Abhishek Shenoy Allison R.Schulman Division of Gastroenterology and Hepatology University of MichiganMichigan MedicineAnn ArborMIUSA Department of Surgery University of MichiganMichigan MedicineAnn ArborMIUSA

The obesity epidemic in the USA and worldwide is well documented and continues to grow.endoscopic metabolic and bariatric therapies may offer a less invasive approach than surgical intervention.This article will review advances in endobariatrics over the last several decades,addressing the past and current state of bariatric and metabolic endoscopy.Food and Drug Administration-cleared devices and interventions currently under investigation are described including gastric devices,gastric remodeling procedures,small-bowel devices,duodenal ablation,as well as procedures to address weight regain after bariatric surgery.Future studies evaluating gastric and duodenal combination therapy,adjunctive pharmacotherapy,as well as individualized precision-health algorithms are underway.

关键词： metabolic devices Endoscopic sleeve gastroplasty obesity endobariatrics bariatric therapy

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How to establish an endoscopic bariatric practice

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World Journal of Gastrointestinal Endoscopy 2024年第4期16卷 178-186页

作者： Daniel B Maselli Lauren L Donnangelo Brian Coan Christopher E McGowan Clinical Research True You Weight LossAtlantaGA 30342United States Clinical Research True You Weight LossCaryNC 27513United States

Obesity is a chronic,progressive,and relapsing disease of excess adiposity that contributes to more than two hundred medical conditions and is projected to affect more than half the adult population of the United States by the year 2030.Given the limited penetrance of traditional bariatric surgery,as well as the cost and adherence barriers to anti-obesity medications,there is growing interest in the rapidly evolving field of endoscopic bariatric therapies(EBTs).EBTs are minimally invasive,same-day,per-oral endoscopic procedures and include Endoscopic sleeve gastroplasty,intragastric balloons,and endoscopic bariatric revisional procedures.This field represents an exciting and innovative subspe-cialty within gastroenterology.However,building a successful endoscopic bariatric practice requires intentional,coordinated,and sustained efforts to overcome the numerous obstacles to entry.Common barriers include acquisition of the technical and cognitive skillset,practice limitations including the availability of nutrition counseling,facility capabilities,direct-to-consumer marketing,and financial pressures such as facility and anesthesia fees.As the highest-volume center for metabolic and bariatric endoscopy in the United States,we provide insights into successfully establishing an endoscopic bariatric program.

关键词： Obesity endoscopic bariatric therapies Bariatric endoscopy Endoscopic sleeve gastroplasty Intragastric balloon Practice management

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endoscopic therapy of weight regain after bariatric surgery

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1584-1596页

作者： Milutin Bulajic Salvatore Francesco Vadalà di Prampero Ivo Boškoski Guido Costamagna Department of Gastroenterology and Digestive Endoscopy Mater Olbia HospitalOlbia 07026Italy Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic factors.Surgical revision of these patients has significant risks and limited benefits.endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective,safe,less invasive and even reproducible treatment.We herein discuss the indication,selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery.Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

关键词： Morbid obesity Weight regain Endoscopic sleeve gastroplasty Transoral outlet reduction Bariatric surgery Full thickness suturing

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