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Endoscopic appearance of the stomach before and after endoscopic sleeve gastroplasty. (A) Normal stomach. (B) A reduced gastric volume after transmural suturing in ESG.
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The prevalence of obesity has risen exponentially, and patients living with obesity suffer from its debilitating consequences. The treatment options for obesity have expanded significantly and include lifestyle changes, pharmacotherapy, endoscopic bariatric therapies (EBTs), and bariatric surgery. Endoscopic bariatric therapies comprise volume-redu...
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Introduction
Endoscopic sleeve gastroplasty (ESG) is a novel endoscopic bariatric therapy that complements current medical and surgical therapeutic offerings for weight management and fills an unmet need. Few meta-analyses compared ESG to laparoscopic sleeve gastrectomy (LSG). However, these studies relied on indirect evidence derived from non-comp...
Obesity and its associated comorbidities, such as diabetes mellitus, hypertension, and cardiovascular disease, are one of today's most pressing health issues and increasing incidence of obesity has marked it a global health challenge. For obese individuals with a high risk of morbidity and mortality who have not lost enough weight with lifestyle an...
Obesity has been escalating as one of the worst public health epidemics. Conservative therapies including lifestyle modifications and weight loss medications have limited efficacy and long-term sustainability. Bariatric surgeries, although effective, remain underutilized due to their cost, safety concerns, and patient acceptance. In the past two de...
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. Endoscopic sleeve gastroplasty (ESG) has proven to be feasible, safe, and effective in the management of obesity. We performed the first systematic review and meta-analysis evaluating NAFLD and other metabolic parameters 12 months post-ESG. Four observati...
Citations
... As emphasized above, we believe registered dieticians are mandatory members of an EBT practice [54]. Obesity is a chronic, progressive, multifactorial, relapsing condition, and any intervention aimed at weight loss should be offered and supported in conjunction with longitudinal aftercare focused on behavior change [1]. ...
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 subspecialty 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.
... Due to their minimally invasive nature and ease of application, endoscopic bariatric therapies are increasingly adopted as a treatment option for obesity in several centers. These procedures mainly achieve weight loss by inducing early satiety and reducing meal volume [3]. ...
Introduction: Obesity is a chronic and multifactorial disease that affects more than 2.2 billion people worldwide. Treatment options for obesity have expanded significantly and include lifestyle changes, pharmacotherapy, endoscopic bariatric therapies, and bariatric surgery. Objective: It was to carry out a systematic review to present the main considerations regarding the use of the intragastric balloon as bariatric endoscopic therapy and nutritional therapy in an attempt to achieve successful weight loss in patients with obesity. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to August 2023 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 129 articles were found. A total of 34 articles were evaluated in full and 24 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 12 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =74.7% >50%. In the challenges against super obesity and comorbidities, the use of endoscopic devices has been reported for many years, with the majority of positive results for patients. These devices are gaining increasing acceptance, and the Food and Drug Administration (FDA) has approved three endoscopic devices for use. Patients should be carefully assessed nutritionally and medication-wise and advised on the most appropriate route. To promote long-term adherence, any dietary intervention must take into account patients' dietary preferences, cultural context, and food availability. Ideally, use a combination of Mediterranean and high-protein diets to promote weight loss based on the patient's preference.
... Nonetheless, adherence to lifestyle modifications and multidisciplinary follow-up is essential for weight loss maintenance. [60] ...
The rising prevalence of obesity in Singapore is a harbinger for a corresponding increase in obesity-related complications such as type 2 diabetes mellitus (T2DM) and coronary heart disease. Obesity is a complex disease driven by multiple factors, and hence, treatment cannot follow a 'one-size-fits-all' approach. Lifestyle modifications involving dietary interventions, physical activity and behavioural changes remain the cornerstone of obesity management. However, similar to other chronic diseases such as T2DM and hypertension, lifestyle modifications are often insufficient on their own, hence the importance of other treatment modalities including pharmacotherapy, endoscopic bariatric therapy and metabolic-bariatric surgery. Weight loss medications currently approved in Singapore include phentermine, orlistat, liraglutide and naltrexone-bupropion. In recent years, endoscopic bariatric therapies have evolved as an effective, minimally invasive and durable therapeutic option for obesity. Metabolic-bariatric surgery remains the most effective and durable treatment for patients with severe obesity, with an average weight loss of 25%-30% after one year.
... We encouraged protein intake (1.5 g/kg/day) to prevent lean muscle mass. 11,13 In the first two weeks post-ESG, we encouraged patients to walk and restrict techniques that increased intraabdominal pressure. Subsequently, depending on the patient's capacity, we devised an individualized exercise plan, such as a treadmill, stair-climbing, jumping jacks, and squats (approximately 30-45 min/day). ...
Background and aim:
Endoscopic sleeve gastroplasty (ESG) is an effective treatment for obesity. Recently, a novel single-channel endoscopic suturing device has been made available to overcome the need for a double-channel endoscope. However, there is limited evidence evaluating its utility for ESG. In this multicenter study, we aim to assess the efficacy and safety of the single-channel suturing device for ESG.
Methods:
We reviewed the records of 18 patients who underwent ESG using the novel device at the Singapore General Hospital, Singapore, and Siriraj Hospital, Bangkok, between 2020-2021. We adopted a "U" suture pattern. Our primary outcome was to assess technical feasibility and safety. The secondary outcome was to determine the percentage of total body weight loss at 1 year.
Results:
The mean ± SD age and body mass index were 42 ± 8.5 years and 34.9 ± 4.4 kg/m2, respectively. The majority were female (61%). ESG was technically successful in 94% (n = 17) of patients. Device dislodgement occurred in one patient. We used an average of five sutures (range, 4-8), and the mean ± SD procedure time was 96.5 ± 43.8 min. No complications occurred. The mean ± SD length of stay was 2.3 ± 1.5 days. The mean ± SD percentage of total body weight loss at 6 and 12 months were 16 ± 5.2% and 13.1 ± 5.8%, respectively. We found that >5%, >10%, and >15% total body weight loss was observed in 83.3%, 72.2%, and 56%, respectively.
Conclusion:
ESG using the single-channel endoscopic suturing system is safe and effective for inducing weight loss at 1 year in patients with obesity.
A obesidade é um problema de saúde pública do século XXI, afetando milhões de pessoas globalmente. Essa condição, resultado de uma combinação complexa de fatores biológicos, ambientais e socioeconômicos, vai além da aparência física, causando comorbidades e impactando o bem-estar físico, mental e social. A cirurgia bariátrica, uma opção para casos graves e crônicos, objetiva reduzir o tamanho do estômago ou modificar o sistema digestivo, promovendo perda de peso e melhorias na saúde, porém requer avaliação e acompanhamento rigorosos. A obesidade tem implicações profundas para a saúde pública e a economia, exigindo políticas governamentais que promovam estilos de vida saudáveis e campanhas de conscientização. Este trabalho revisa a literatura sobre a perda de peso após cirurgia bariátrica, analisa fatores associados, complicações e estratégias pós-cirúrgicas, visando contribuir para uma sociedade mais saudável e resiliente diante dos desafios da obesidade. Foi conduzida uma pesquisa sistemática da literatura, encontrando 28 artigos atendiam aos requisitos e utilizavam termos relacionados à perda de peso após cirurgia bariátrica. A perda de peso após cirurgia bariátrica é influenciada por fatores interligados, destacando-se a adesão rigorosa às orientações médicas, a qual promove uma perda de peso mais sustentada ao longo do tempo. Diversos procedimentos cirúrgicos, como bypass gástrico e gastrectomia vertical, também exercem impacto significativo na perda de peso pós-operatória. O acompanhamento pós-operatório, liderado pelo médico, desempenha papel crítico, permitindo ajustes estratégicos e identificação de desafios. Além do monitoramento físico, o apoio emocional do médico é essencial, considerando as mudanças psicológicas e emocionais dos pacientes após a cirurgia. A análise das pesquisas revela o papel crucial do médico como parte fundamental da equipe multidisciplinar que guia o paciente ao longo do processo cirúrgico, desde a avaliação até a fase pós-operatória. Essa relação influencia a adesão às orientações, prevenção de complicações e obtenção de resultados bem-sucedidos. As limitações dos estudos incluem falta de padronização nos métodos de avaliação e dados retrospectivos, o que pode gerar vieses. A ausência de acompanhamento a longo prazo também limita a avaliação dos resultados. Futuras pesquisas podem se concentrar em estudos prospectivos com critérios uniformes e amostras maiores, além de explorar fatores genéticos, microbiota, marcadores oxidativos e inflamatórios. Estratégias de acompanhamento, manutenção de peso e impactos psicossociais também merecem investigações, enriquecendo a compreensão global dos efeitos da cirurgia bariátrica.
Nutrition-focused interventions are essential to optimize the bariatric care process and improve health and weight outcomes over time. Clear and detailed reporting of these interventions in research reports is crucial for understanding and applying the findings effectively in clinical practice and research replication. Given the importance of reporting transparency in research, this study aimed to use the Template for Intervention Description and Replication (TIDieR) checklist to evaluate the completeness of intervention reporting in nutritional weight management interventions adjunct to metabolic and bariatric surgery (MBS). The secondary aim was to examine the factors associated with better reporting. A literature search in PubMed, PsychINFO, EMBASE, Scopus, and the Cochrane Controlled Register of Trials was conducted to include randomized controlled trials (RCT), quasi-RCTs and parallel group trials. A total of 22 trials were included in the final analysis. Among the TIDieR 12 items, 6.6 ± 1.9 items were fully reported by all studies. None of the studies completely reported all intervention descriptors. The main areas where reporting required improvement were providing adequate details of the materials and procedures of the interventions, intervention personalization, and intervention modifications during the study. The quality of intervention reporting remained the same after vs. before the release of the TIDieR guidelines. Receiving funds from industrial organizations (p = 0.02) and having the study recorded within a registry platform (p = 0.08) were associated with better intervention reporting. Nutritional weight management interventions in MBS care are still below the desirable standards for reporting. The present study highlights the need to improve adequate reporting of such interventions, which would allow for greater replicability, evaluation through evidence synthesis studies, and transferability into clinical practice.
Obesity rates have increased, and so has the need for more specific treatments. This trend has raised interest in non-surgical weight loss techniques that are novel, safe, and straightforward. Thus, the present review describes the endoscopic bariatric treatment for obesity, its most recent supporting data, the questions it raises, and its future directions. Various endoscopic bariatric therapies for weight reduction, such as intragastric balloons (IGBs), aspiration therapy (AT), small bowel endoscopy, endoscopic sleeve gastroplasty, endoluminal procedures, malabsorption endoscopic procedures, and methods of regulating gastric emptying, were explored through literature sourced from different databases. IGBs, AT, and small bowel endoscopy have short-term effects with a possibility of weight regain. Minor adverse events have occurred; however, all procedures reduce weight. Vomiting and nausea are common side effects, although serious complications have also been observed.
La cirugía bariátrica, al igual que la obesidad, ha tenido un reconocimiento tardío en la comunidad científica. Desde 1996, la Fundación Santa Fe de Bogotá ha contribuido al manejo de la obesidad y al desarrollo de la cirugía bariátrica desde un enfoque multidisciplinario. El abordaje del problema por cirujanos, endocrinólogos, psiquiatras, nutricionistas, enfermeras y médicos deportólogos, ha permitido la modificación de hábitos y el mantenimiento de soporte médico, nutricional, motivacional y emocional de los pacientes para lograr sus objetivos a largo plazo. A lo largo de los años, el Centro de Cuidado Clínico para la Obesidad de la Fundación Santa Fe de Bogotá, fiel a las enseñanzas del doctor José Félix Patiño Restrepo, hapromovido la investigación, la educación y el avance en los tratamientos y procedimientos quirúrgicos para el manejo efectivo y seguro de la obesidad. El objetivo de este documento es hacer un recuento de dicha experiencia.
