The IFSO Bariatric Endoscopy Committee has endorsed endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity, noting that the procedure is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for bariatric metabolic surgery (BMS). The endorsement is the result of comprehensive systematic review and meta-analysis of ESG by the Committee. The recommendations were made in the paper, ‘IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management’, published in Obesity Surgery.
The committee noted that a recent IFSO International Delphi Consensus Study highlighted that multidisciplinary experts agree on the utility of ESG for managing obesity in patients with class I and II obesity and for those with class III obesity who do not wish to pursue or qualify for BMS. As a result, the IFSO Bariatric Endoscopy Committee conducted a comprehensive systematic review of the evidence and delivering an evidence-based position on the value of ESG within the spectrum of obesity management.
The systematic review included 44 articles including 15,714 patients receiving ESG and 34,134 controls (including LSG, laparoscopic adjustable gastric banding and IGB). The studies varied from 29 case series, 14 cohort studies and the Multi-Center Endoscopic Sleeve Gastroplasty (ESG) Randomized Interventional Trial (MERIT).
It is important to note this IFSO Bariatric Endoscopy Position Statement investigated ESG utilising the Apollo Overstitch platform (Boston Scientific) based on the maturity of the technique, regulatory approvals and cost-effectiveness. Other endoscopic gastric remodelling techniques, including the Primary Obesity Surgery Endoluminal 2.0 (USGI Medical), Endomina Gastric Plication (Endo Tools) and the Endozip automated suturing device (Caesarea), are at different stages of clinical trials and evidence generation and are demonstrating similar safety and efficacy profiles. The committee said it will update its position statement to reflect and incorporate the evolving evidence base as the clinical evidence continues to mature for these procedures.
The Position Statement notes that there is a crucial role of integrating and complementing any obesity intervention, such as ESG, with a comprehensive and longitudinal healthy living program – including a healthy diet, physical activity, adequate sleep and mindfulness to maintain the weight loss benefits and maximise the overall impact on health by the intervention.
“ESG provides significant weight loss outcomes and demonstrates a favourable safety profile with a low rate of serious adverse events. Despite the limitations of the included observational studies, the randomised controlled trial included in the analysis reinforces the efficacy and safety of ESG and provides an evidence-based foundation for the position statement,” the Position Statement concluded. “Thus, the IFSO position statement supports and provides an evidence base for the role of ESG within the broader spectrum of obesity management.”
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