Endoscopic Gastroplasty and weight loss

Endoscopic Gastroplasty (EG) is a minimally invasive procedure designed to help manage obesity by reducing the size of the stomach without requiring traditional surgical methods. It is classified as an Endoscopic Bariatric Therapy (EBT), which serves as an alternative to more invasive bariatric surgeries like gastric bypass or sleeve gastrectomy. EG is performed using advanced endoscopic tools that allow the reshaping and suturing of the stomach from within, thereby limiting its capacity and promoting early satiety.

### Techniques of Endoscopic Gastroplasty

There are three primary techniques for performing Endoscopic Gastroplasty:

1. **Endoscopic Sleeve Gastroplasty (ESG):** This technique uses the Apollo Overstitch Sx device (Boston Scientific) to place sutures along the stomach, creating a sleeve-like structure that reduces its volume.

2. **Endoluminal Vertical Gastroplasty (EVG):** This method employs the Endomina system (EndoTools Therapeutics) to perform vertical suturing inside the stomach for size reduction.

3. **Primary Obesity Surgery Endoluminal-2 (POSE-2):** Using the Incisionless Operating Platform (USGI Medical), this technique involves placing anchors or sutures to reduce stomach volume and alter its shape.

### Effectiveness of Endoscopic Gastroplasty

A clinical study conducted between April 2021 and May 2023 evaluated the outcomes of these three techniques on weight loss among 184 obese patients. The results demonstrated that all three methods were equally effective in achieving weight loss, with no statistically significant differences among the techniques. The primary findings include:

• **Total Body Weight Loss (TBWL):** Patients achieved an average of 15.5% at 6 months, 14.5% at 12 months, and 17.1% at 18 months.
• **Excess Weight Loss (EWL):** Patients experienced an average EWL of 39.3% at 6 months, 36.7% at 12 months, and 43.0% at 18 months.

### Safety and Feasibility

Endoscopic Gastroplasty was found to be a safe and feasible procedure with a 100% technical success rate and a low serious adverse event rate of 1.1%. The minimally invasive nature of the procedure contributes to quicker recovery times and reduced risks compared to traditional bariatric surgery.

### Additional Benefits

Beyond weight loss, EG showed significant improvements in:

• **Anthropometric Measurements:** Reduction in waist circumference and overall body fat percentage.
• **Body Composition:** Improved muscle-to-fat ratio.
• **Fatty Liver Disease and Hyperlipidemia:** Marked improvements in liver health and lipid profiles.
• **Quality of Life:** Enhanced scores on the Bariatric Analysis and Reporting Outcome System (BAROS) and the Total Self-Development Obesity Control (TSD-OC) test, indicating better physical, emotional, and social well-being.

### Limitations

The study had incomplete follow-up rates, with only 56% of patients followed at 6 months, 32% at 12 months, and 15% at 18 months. This limitation may have impacted the robustness of the long-term data, although the researchers assumed missing data were random.

### Conclusion

Endoscopic Gastroplasty through ESG, EVG, and POSE-2 is a promising intervention for managing obesity. It provides effective weight loss, improves metabolic health, and enhances quality of life in the medium-term follow-up. Its minimally invasive nature makes it a safer and more feasible option for patients seeking alternatives to surgical bariatric procedures.