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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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Endo-anesthesia:a primer

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Gastroenterology Report 2022年第1期10卷 207-216页

作者： Fateh Bazerbachi Rodger M.White Nauzer Forbes Basavana Goudra Barham K.Abu Dayyeh Vinay Chandrasekhara BobbieJean Sweitzer CentraCare Interventional Endoscopy ProgramSt.Cloud HospitalSt CloudMNUSA department of Anesthesia Massachusetts General HospitalBostonMAUSA department of Medicine Division of Gastroenterology and HepatologyUniversity of CalgaryCalgaryAlbertaCanada department of Anesthesiology and Critical Care Medicine Hospital of the University of PennsylvaniaPhiladelphiaPAUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Systems Director University of VirginiaPreoperative MedicineInovaHealthFalls ChurchVAUSA

Gastrointestinal(GI)endoscopy has witnessed a Cambrian explosion of techniques,indications,and expanding target populations.GI endoscopy encompasses traditional domains that include preventive measures,palliation,as alternative therapies in patients with prohibitive risks of more invasive procedures,and indicated primary treatments.But,it has expanded to include therapeutic and diagnostic interventional endosonography,luminal endoscopic resection,third space endotherapy,endohepatology,and endobariatrics.The lines between surgery and endoscopy are blurred on many occasions within this paradigm.Moreover,patients with high degrees of co-morbidity and complex physiology require more nuanced peri-endoscopic management.The rising demand for endoscopy services has resulted in the development of endoscopy referral centers that offer these invasive procedures as directly booked referrals for regional and rural patients.This further necessitates specialized programs to ensure appropriate evaluation,risk stratification,and optimization for safe sedation and general anesthesia if needed.This landscape is conducive to the organic evolution of endo-anesthesia to meet the needs of these focused and evolving practices.In this primer,we delineate important aspects of endo-anesthesia care and provide relevant clinical and logistical considerations pertaining to the breadth of procedures.

关键词： endoscopic procedures endoscopy anesthesia

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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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