P2978 - Short-Term Outcomes of Endoscopic Sleeve Gastroplasty Using a Box Pattern of Suturing for Treatment of Obesity

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Momin Shah-Khan, MD

West Virginia University Health Sciences Center
Morgantown, WV, United States

Shailendra Singh, MD¹, Momin Shah-Khan, MD¹, Yousaf Hadi, MD¹, Shyam Thakkar, MD¹, Hamza Shah, DO²
¹West Virginia University Health Sciences Center, Morgantown, WV; ²Charleston Gastroenterology, Charleston, WV

Introduction: Endoscopic Sleeve Gastroplasty (ESG) has emerged as a promising endoscopic bariatric therapy for the treatment of obesity. Multiple studies have shown excellent weight loss outcomes with ESG, along with a favorable safety profile. ESG results in a significant reduction in the stomach volume by applying full-thickness sutures at the greater curvature.  ESG technique has not been standardized, and a variety of suturing patterns have been utilized. In this study, we sought to assess the safety and efficacy of ESG for the treatment of obesity using a modified “U” pattern/box pattern of suture placement.

Methods: We performed a retrospective analysis of all ESG procedures at a single center performed by the two therapeutic endoscopists. Patients with a body mass index of >30 kg/m2 who underwent ESG from October 2019 to November 2020 for treatment of obesity were included. The primary outcome was percent total body weight loss (%TWL) at 3 months, 6 months, and 1 year after the ESG procedure and incidence of adverse events. ESG was performed using a box pattern, a modification of the “U” pattern with the addition of longitudinal compression suture bite at the anterior surface (Figure 1). We believe that a box pattern of suturing can provide more equally distributed tension and uniform compression at both anterior and posterior surfaces of the gastric body compared to the “U” pattern (Figure 1).

Results: A total of 54 ESG procedures were included in the final analysis. Out of which, 52 procedures were primary ESG, and 2 were redo ESG. The mean age of these patients was 45.4 years, and the majority of them were females. Table 1 describes the baseline characteristics of patients, procedure characteristics, and outcomes. The mean procedure time 102 minutes, and the mean number of sutures placed was 7. There was no serious adverse event reported. The majority of the patients had post-procedure abdominal pain and nausea, which was controlled with medications. Thirty-five (follow up rate 73%) out of 48 eligible patients had 3 months follow up post ESG. %TWL at 3 months was 12.8% (5.1), while the %TWL at 6 months and 12 months was 15.8% (6.9) and 19.8% (11.3), respectively.

Discussion: Our study shows that ESG using a modified suturing pattern resulted in effective weight loss at the short term follow up without any serious adverse events. ESG technique is evolving, and there is a need for standardization. Future studies should focus on determining the optimal procedure technique.

Figure: Figure 1: Box Pattern and U Pattern of suturing for Endoscopic Sleeve Gastroplasty

Baseline patient characteristics
Age years (S.D)	45.4 (10.0)
Gender Female, N (%)	49 (90.7%)
Race Caucasia,n N (%)	52 (96.3%)
Height inches, mean (S.D)	64.7 (4.3)
Weight Lbs mean, (S.D)	258.3 (46.9)
Body Mass Index Kg/m2 , Mean (S.D)	42.5 (6.7)
Diabetes, N (%) Pre-diabetes, N (%)	12 (22.2%) 15 (27.8%)
Hyperlipidemia, N (%)	22 (42.3%)
Hypertension, N (%)	25 (46.3%)
Fatty Liver or NASH based on Fibroscan or Fibrosure, N (%)	38 (70.4%)
Obstructive Sleep Apnea, N (%)	11 (20.8%)
Gastroesophageal Reflux Disease, N (%)	40 (74.1%)
Procedure Characteristics
Use of Esophageal Overtube, N (%)	39 (72.2%)
Procedure time minute, mean (S.D)	101.7 (19.9)
Total no of sutures, mean (S.D)	7.2 (1.4)
No of reinforcement sutures, mean (S.D)	2.2 (1.0)
Percentage Reduction in longitudinal dimension (GE junction to antrum) of stomach, mean (S.D)	50.6% (11.9)
Outcomes
Post procedure Nausea, N (%)	32 (59.2%)
Post procedure abdominal pain, N (%)	32 (59.2%)
Percent Total Weight loss (TWL), mean (S.D) 3 months (N=35, Follow-up rate 73%) 6 months (N=21, Follow-up rate 75%) 12 months (N=6, follow-up rate 67%)	12.8% (5.1) 15.8% (6.9) 19.8% (11.3)
Serious Adverse Events	0
Minor Adverse Events N (%) Diarrhea self-limiting Dehydration requiring IV fluids as an outpatient Back Pain Admitted for observation with abdominal pain and constipation Required CPAP post-extubation admitted for observation	1 (1.8%) 3 (5.5%) 1 (1.8%) 1 (1.8%) 1 (1.8%)

Table: Table 1: Baseline characteristics of patients, procedure characteristics, and outcomes of Endoscopic Sleeve Gastroplasty.

Disclosures:

Shailendra Singh indicated no relevant financial relationships.

Momin Shah-Khan indicated no relevant financial relationships.

Yousaf Hadi indicated no relevant financial relationships.

Shyam Thakkar indicated no relevant financial relationships.

Hamza Shah indicated no relevant financial relationships.

Shailendra Singh, MD¹, Momin Shah-Khan, MD¹, Yousaf Hadi, MD¹, Shyam Thakkar, MD¹, Hamza Shah, DO². P2978 - Short-Term Outcomes of Endoscopic Sleeve Gastroplasty Using a Box Pattern of Suturing for Treatment of Obesity, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.