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. 2024 May;34(5):1496-1504.
doi: 10.1007/s11695-024-07109-4. Epub 2024 Mar 7.

Success Predictors of Endoscopic Sleeve Gastroplasty

Maria Valeria Matteo  1   2 , Vincenzo Bove  1   2 , Gabriele Ciasca  3   4 , Giorgio Carlino  1   2 , Riccardo Di Santo  3   4 , Laila Vinti  1 , Giulia Polidori  5 , Valerio Pontecorvi  1 , Massimiliano Papi  3   4 , Cristiano Spada  6   7 , Ivo Boškoski  1   2
Affiliations

Success Predictors of Endoscopic Sleeve Gastroplasty

Maria Valeria Matteo et al. Obes Surg. 2024 May.

Abstract

Objective: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that proved to be safe and effective in obesity treatment. However, not all subjects respond to treatment in the same way, and, with a view to personalized care, it is essential to identify predictors of success or failure.

Methods: A retrospective 2-year followed-up cohort of ESG subjects was analyzed to investigate the presence of any baseline or early indicators of long-term optimal or suboptimal ESG outcomes.

Results: A total of 315 subjects (73% women) were included, with 73% of patients exhibiting an Excess weight loss percentage (%EWL) >25% at the 24 months. Neither demographic parameters (age and sex), smoking habits, and menopause in women nor the presence of comorbidities proved potential predictive value. Interestingly, the %EWL at 1 month after ESG was the strongest predictor of 24-month therapeutic success. Subsequently, we estimated an "early threshold for success" for 1 month-%EWL by employing Youden's index method.

Conclusions: ESG is a safe and effective bariatric treatment that can be offered to a wide range of subjects. Early weight loss seems to impact long-term ESG results significantly and may allow proper early post-operative care optimization.

Keywords: ESG; Endoscopic sleeve gastroplasty; Obesity; Predictors.

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Conflict of interest statement

Ivo Boskoski is a consultant for Apollo Endosurgery, Boston Scientific, Nitinotes, Pentax, Cook Medical, Microtech, ERBE, and Endo Tools Therapeutics S.A. Cristiano Spada is a consultant for Medtronic and AnX Robotics and received speaker’s fees from Olympus and Pentax. All the other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
ESG performed with the OverStitch Sx mounted on a single-channel gastroscope. A Tip of the device (needle driver) closed to allow loading of the suture delivered from the a dedicated accessory (anchor exchange, not visible); B tip of the device open while grasping the gastric wall by a dedicated accessory (Tissue Helix); C, D full-thickness passage of the suture line at the anterior wall; E multiple full-thickness passages of the sutures along the greater curvature with a U-shaped pattern, before tightening with a dedicated accessory (Suture Cinch, not visible); F final result of ESG
Fig. 2
Fig. 2
Temporal trends of %EWL, %TBWL, and BAROS score. Data are reported as median values. Equation 1 is fitted to the experimental points (blue-dashed line)
Fig. 3
Fig. 3
Correlation matrix among age, %EWL %TBWL, and BAROS score at different time points. Data are presented using Spearman’s correlation coefficient. White cells indicate non-significant correlations. A double scale is used to indicate the strength of the correlation. Larger and more intense squares indicate stronger positive (blue) and negative (gold) correlations
Fig. 4
Fig. 4
A Box plot analysis of %EWL at 1 month in “poor responders” (EWL%<39% at 24 months) and “good responders” (defined according to EWL%≥39% at 24 months), which are indicated with 0 and 1, respectively. B ROC curve analysis for evaluating the performance of %EWL in distinguishing between the two groups
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