Endoscopic Versus Surgical Sleeve Gastrectomy for Weight Loss: Is One Better Than the Other?

Stomach and Small Bowel

Vanessa M. Shami, MD, FASGE reviewing Fayad L, et al. Gastrointest Endosc 2018 Aug 24.

Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study

Laparoscopic sleeve gastrectomy (LSG) is the most common surgery performed for weight loss. However, with advances in therapeutic endoscopy and the ability to suture, endoscopic sleeve gastroplasty (ESG) is now being performed in specialized endoscopy centers. The potential advantages of ESG are that it is less invasive, potentially reversible, and less costly. This is the first case-matched study that compares the outcomes and adverse events of the two procedures.

In this study, 83 LSG patients were matched to 54 ESG patients by age, sex, and body mass index. The proportion of GERD was similar between both groups. At the 6-month follow-up, percent total body weight loss was significantly higher for the LSG group versus the ESG group (23.6% vs 17.1%). The adverse event rate was also significantly higher for LSG patients than ESG patients (16.9% vs 5.2%). Additionally, new-onset GERD was significantly higher for the LSG group versus the ESG group (14.5% vs 1.9%).

Comment:

ESG is a same-day procedure that has the potential to change the way we manage obesity. While ESG is an attractive alternative to surgery, it is technically difficult and requires an endoscopist with expertise in suturing. Additionally, it may not be as efficacious for weight loss, but it may be associated with fewer adverse events. While important, the comparative data from this study should be viewed as exploratory, and a randomized prospective trial is warranted to more definitively compare these two techniques.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Vanessa M. Shami, MD, FASGE

Bio and Disclosures

Citation(s):

Fayad L, Adam A, Dunlap M, et al. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc 2018 Aug 24. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2018.08.030)