Improvement in Obesity-related Comorbidities 5 Years After Endoscopic Sleeve Gastroplasty: a Prospective Cohort Study

Background And Aims: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure of the gastric cavity to facilitate weight loss. We aimed to evaluate the long-term effects of ESG as a monotherapy on obesity-related comorbidities over 5 years.

Methods: This prospective study analyzed data from 404 consecutive patients (aged 45 ± 11.9 years, 76% women) who underwent ESG from August 2013 through June 2024. All patients had body mass indices ≥30 or ≥27 kg/m with comorbidities. Patients receiving adjuvant therapy were excluded to assess ESG as a monotherapy. All procedures were performed with a flexible endoscopic suturing system to facilitate restriction of the stomach. Patients were evaluated after 12 months (n = 336), 36 months (n = 210), and 60 months (n = 196) for anthropometric features, clinical parameters, metabolic panels, and liver function tests. Primary outcomes were the effects of ESG on obesity-related comorbidities and metabolic biomarkers. Secondary outcomes were total body weight loss (TBWL) and safety.

Results: At 5 years after ESG, patients had significant reductions in levels of hemoglobin A1c (Δ .42%, P = .0007), systolic blood pressure (Δ 4.1 mm Hg, P = .0071), and alanine aminotransferase (Δ 7.4 U/L, P = .002). Body mass indices before the procedure were 37.5 ± 5.8 and 33.8 ± 6.7 kg/m at 60 months (P < .001). TBWL was 13.4% at 12 months (84.5% follow-up), 9.9% at 36 months (63.3% follow-up), and 11.8% at 60 months (74.8% follow-up), with 3 moderate adverse events (.7%).

Conclusions: ESG is an effective, noninvasive monotherapy that improved markers of hypertension, diabetes, and metabolic dysfunction-associated steatotic liver disease and led to a TBWL of 11.8% at 5 years after the procedure. (Clinical trial registration number: NCT04494048.).