Evidence is building exponentially for the metabolic endoscopic techniques that provide alternatives to bariatric surgery for patients struggling with obesity.
Brisbane gastroenterologist Dr Jason Huang, who specialises in advanced diagnostic and therapeutic endoscopy, told AGW 2019 in Adelaide that endoscopic sleeve gastroplasty led to total body weight losses (TBWL) of about 15%.
He presented a number of recent studies that demonstrated the procedure was consistent and effective with a low rate of serious adverse events.
In an Australian and US series of 112 patients with an average BMI of 37.9, the TBWL was 14.9% at six months and excess weight loss (EWL) was 50.3%. The surgery was performed as a day procedure with only three (2.7%) serious adverse events such as a bleed or a leak.
Dr Huang said the procedure was ideal for non-surgical candidates such as patients with comorbidities or those who did not want surgery.
However patients should have realistic expectations for their weight loss and a satisfactory psychiatric evaluation.
In another series of 193 patients from Brazil and the US, TBWL was 15.06% and EWL was 59.41% at 12 months. Serious adverse events (1.03%) were two perigastric leaks requiring surgery.
And a larger study of 1,000 patients from Saudi Arabia had confirmed short-term TBWL outcomes of 14.8% at 18 months.
In another study (in press) of 203 patients with longer follow-up, TBWL was 14.5% at five years.
He said the technique, including suture patterns, was still evolving and there was a need for both more data and more long-term data.
“The longest follow-up is actually five years which is, relatively speaking, not long enough. But as with any new technique and new breakthroughs, it takes time to build that data. And likewise with bariatric surgery, when it first started it didn’t have any long-term data either so the data will come with time.”
He said the data was mature enough to have generated a meta-analysis of nine studies and 1,542 patients, which found it was “a promising minimally invasive alternative for treating obesity with satisfactory efficacy and low risk”.
The other endoscopic technique of particular interest was the transoral outlet reduction (TORe), which can help reverse weight gain following Roux-en-Y gastric bypass.
Dr Huang said it had proved to be a well-tolerated day procedure with patients likely to lose about 10 kg. Side effects were uncommon but typically nausea, abdominal pain and GI bleeding.
A US series of 252 patients found TBWL was 9.6 kg at six months. Other outcomes were improvements in HbA1c, blood pressure and ALT levels.
He added that the duodenal-jejunal bypass liner was making a comeback and had been shown to be particularly helpful in improving glycaemic control.
Duodenal mucosal resurfacing had also been shown recently to improve glycaemic control in patients with suboptimally controlled type 2 diabetes irrespective of their weight loss.
Dr Huang said different procedures would suit different patients.
“You can’t apply the same treatment to everyone – that’s why there is medical, endoscopic, lifestyle and surgery. The patient needs to be assessed to see which one they are willing to undergo and which option is most suitable for their situation.”