A subgroup analysis looked at patients with a baseline body mass index below or above 40 kg/m2, and found even after adjustment for age and sex, both groups showed significantly more weight loss at 1 and 3 months for patients who underwent gastroplasty. However, at 6 and 12 months, the study saw no significant difference between gastroplasty and the therapy program for patients with a baseline BMI above 40 kg/m2.
While the cause of this difference in effect in higher BMI patients was unknown, it may be that sleeve gastroplasty is less effective because it is counteracted by neurohormonal effects that are altered with bariatric surgery, the authors wrote.
“This is worth exploring in future randomized control trials because it will give us insight into which patients are superior candidates for endoscopic bariatric therapy,” they wrote.
There were five moderate to severe adverse events in the gastroplasty cohort and none in the therapy group. There were three cases of upper gastrointestinal bleeding caused by gastric ulceration. In one case, the patient underwent diagnostic endoscopy, admission, and 48-hour monitoring. Another patient developed perigastric fluid collection, and one was admitted for intravenous hydration after experiencing dehydration. Despite this, the authors suggested the adverse event rate associated with the procedure may be acceptable to patients because of the superior weight loss effect compared with therapy programs.
No funding was declared. Three authors declared consultancies, advisory board positions, and personal fees from medical device companies including those in the endoscopy space. No other conflicts of interest were declared.
SOURCE: Cheskin L et al. Gastrointest Endosc. 2019 Sep 27. doi: 10.1016/j.gie.2019.09.029.