Does endoscopic sleeve gastroplasty stand the test of time? Objective assessment of endoscopic ESG appearance and its relation to weight loss in a large group of consecutive patients

Introduction Endoscopic sleeve gastroplasty (ESG) is a promising bariatric treatment. Gastric volume reduction and delayed gastric emptying are the probable mechanisms driving weight loss. However, there are concerns regarding the overtime ESG effectiveness. This study aims to evaluate the correlation between endoscopic gastroplasty integrity overtime and weight loss. Patients and methods Patients undergoing follow-up endoscopy (6 and 12 months) after ESG were included. ESG were classified in three groups according to endoscopic appearance: open when all the stiches were loose; partially intact if at least one stitch was loose; intact if all the stitches were present and tight. Initial BMI, excess weight loss (%EWL) and total weight loss (%TWL) at 6 and 12 months were assessed against gastroplasty endoscopic appearance. Results From October 2016 to April 2019, 133 patients underwent ESG, 87 (65.4%) had a follow-up EGD at 6 months. ESG was open in six cases (6.9%), partially intact in 38 (43.7%) and intact in 43 (49.4%). The overall %EWL and %TWL was 34.5 +/- 19.8 and 13.2 +/- 7.4, respectively; 25.7 +/- 26.9 and 11.8 +/- 11.8 for the open group, 30.8 +/- 20.1 and 12.4 +/- 7.8 for the partially intact group; 39.1 +/- 19.7 and 14.0 +/- 6.4 for the intact gastroplasty. Forty-one patients underwent a 12 months endoscopy: 10 (24.4%) had an intact ESG, 24 (58.5%) had a partially intact gastroplasty, and in 7 (17.0%) cases the sutures were lost. Overall %EWL and %TWL at 12 months was 34.3 +/- 21.9 and 13.1 +/- 8.1: 19.3 +/- 13.4 and 8.9 +/- 6.1 for the open group; 36.0 +/- 24.2 and 13.1 +/- 8.9 for the partially intact group; 40.3 +/- 17.3 and 17.2 +/- 5.4 for the intact group. ESG appearance correlated with preoperative BMI (r0.34;p0.001) and %EWL at 6 months (r0.22;p0.035) and 12 months (r0.29;p0.065). Conclusion This preliminary work shows that weight loss correlates with ESG endoscopic appearance over time. Initial BMI predicts endoscopic suture duration over time. Larger studies and longer follow-up are needed.