July 15, 2017
Unprecedented rates of obesity and escalation of comorbid conditions have created an enormous economic burden on the American health care system. Only 1 percent of eligible patients undergo bariatric-metabolic surgery, the only currently available treatment for obesity with demonstrated long-term efficacy. Limited access, patient preference, risks and surgery cost are factors contributing to the low utilization rate associated with this surgical procedure.
Endoscopic bariatric therapies
Endoscopic bariatric therapies were developed to offer a lower cost, effective weight-loss intervention that might gain greater patient acceptance. First developed and introduced at Mayo Clinic's campus in Minnesota in 2012, endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that reduces the size of the stomach. Mayo Clinic has offered this option to select patients since 2013.
In a prospective study of obese individuals published in Clinical Gastroenterology and Hepatology, Mayo Clinic researchers investigated the procedure's durability and effects on body weight and gastrointestinal function. The study included 25 obese individuals (21 female, 4 male, with a mean body mass index of 35.5 ± 2.6 kg/m2; mean age 47.6 ± 10 years) who underwent ESG with endoluminal creation of a sleeve along the gastric lesser curve, from September 2012 through March 2015 at Mayo Clinic's campus in Rochester, Minnesota.
A larger retrospective study of 248 patients from three centers, including Mayo Clinic, was published in April 2017 in Obesity Surgery.
Key findings from ESG studies
At six and 24 months:
- The percent total body weight loss was 15.2 (95 percent confidence interval [CI], 14.2-16.3) and 18.6 (95 percent CI, 15.7-21.5).
- Incidence of adverse events was low (2 percent), and all patients made full recoveries with no need for surgical interventions.
- Post-procedure physiological analyses of a small cohort of patients showed a decrease of 59 percent in caloric consumption to reach maximum fullness (P = 0.003), slowing of gastric emptying of solids (P = 0.03) and a trend toward increased insulin sensitivity (P = 0.06).
"For an endoscopic bariatric therapy to have a meaningful impact on obesity, it should reach a certain threshold of efficacy that is balanced with the risks and cost of the intervention," says the studies' lead author, Barham K. Abu Dayyeh, M.D., M.P.H., a gastroenterologist specializing in bariatric and metabolic endoscopy at Mayo Clinic's campus in Rochester, Minnesota. "These studies demonstrated the efficacy of ESG as a minimally invasive endoscopic intervention for obesity. Our data confirm that ESG delays gastric emptying, induces early satiation and significantly reduces body weight."
Overall, Dr. Abu Dayyeh and colleagues note that the significant weight loss observed, reproducibility of the results among independent centers, and the anatomic durability of the intervention suggest that ESG is a cost-effective intervention for obese individuals who do not undergo bariatric surgery.
"ESG offers a paradigm shift in our management of obesity that targets current gaps in therapy and may allow us to gain ground in our battle against obesity," says Dr. Abu Dayyeh.
ESG is offered at the Mayo Clinic's campus in Rochester, Minnesota, as part of a comprehensive nonsurgical weight management program. In addition to weight loss, the program helps patients achieve wellness goals and make lifelong changes for a healthier lifestyle. It is the first program in the nation to combine new state-of-the-art endoscopic weight-loss interventions, such as endoscopic sleeve gastroplasty and lifestyle modification, through Mayo Clinic's Healthy Living Program.
The ultimate goal is to have patients lose excess weight and maintain the weight loss long-term for an impactful health benefit. Patients can be referred to the nonsurgical weight management program. To learn more, call 507-538-1565. To make an appointment, call 507-284-2111 and mention endoscopic sleeve gastroplasty.
For more information
Abu Dayyeh BK, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clinical Gastroenterology and Hepatology. 2017;15:37.
Lopez-Nava G, et al. Endoscopic sleeve gastroplasty for obesity: A multicenter study of 248 patients with 24 months follow-up. Obesity Surgery. In press.