title: Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients.
abstract: OBJECTIVE
  Endoscopic sleeve gastroplasty (ESG) is an incisionless, minimally invasive bariatric procedure that reduces the length and width of the gastric cavity to facilitate weight loss. We performed a prospective study to evaluate the effects of ESG on total body weight loss and obesity-related comorbidities.
  
  
  METHODS
  We collected data from 91 consecutive patients (mean age, 43.86 ± 11.26 years; 68% female) undergoing ESG from August 2013 through March 2016. All patients had a body mass index (BMI) greater than 30 kg/m2and had failed noninvasive weight-loss measures or had a BMI greater than 40 kg/m2and were not considered as surgical candidates or refused surgery. All procedures were performed with a cap-based flexible endoscopic suturing system to facilitate a triangular pattern of sutures to imbricate the greater curvature of the stomach. Patients were evaluated after 6 months (n = 73), 12 months (n = 53), and 24 months (n = 12) for anthropometric features (BMI, weight, waist circumference, blood pressure) and underwent serologic (hemoglobin A1c), lipid panel, serum triglycerides, and liver function tests. The primary outcomes were total body weight loss at 6, 12, and 24 months. Secondary outcomes were the effects of ESG on metabolic factors (blood pressure, diabetes, hyperlipidemia, steatohepatitis) and safety.
  
  
  RESULTS
  The patients' mean BMI before the procedure was 40.7 ± 7.0 kg/m2. Patients had lost 14.4% of their total body weight at 6 months (80% follow-up rate), 17.6% at 12 months (76% follow-up rate), and 20.9% at 24 months (66% follow-up rate) after ESG. At 12 months after ESG, patients had statistically significant reductions in levels of hemoglobin A1c (P = .01), systolic blood pressure (P = .02), waist circumference (P < .001), alanine aminotransferase (P < .001), and serum triglycerides (P = .02). However, there was no significant change in low-density lipoprotein after vs before ESG (P = .79). There was one serious adverse event (1.1%) (perigastric leak) that occurred that was managed non-operatively.
  
  
  CONCLUSIONS
  ESG is a minimally invasive and effective endoscopic weight loss intervention. In addition to sustained total body weight loss up to 24 months, ESG reduced markers of hypertension, diabetes, and hypertriglyceridemia.
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York. Electronic address: rzs9001@med.cornell.edu.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Monica
authors.initials: M
authors.lastname: Saumoy
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Desai
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Sarkisian
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benevenuto
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Department of Endocrinology, Weill Cornell Medicine, New York, New York.
authors.forename: Rekha
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Endocrinology, Weill Cornell Medicine, New York, New York.
authors.forename: Leon
authors.initials: L
authors.lastname: Igel
authors.affiliation: Department of Gastroenterology, Columbia University Medical Center, New York, New York.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Schwartz
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Christina
authors.initials: C
authors.lastname: Frissora
authors.affiliation: Department of Endocrinology, Weill Cornell Medicine, New York, New York.
authors.forename: Alpana
authors.initials: A
authors.lastname: Shukla
authors.affiliation: Department of Endocrinology, Weill Cornell Medicine, New York, New York.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Aronne
authors.affiliation: Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015228:Hypertriglyceridemia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ALT; Bariatric Surgery; Metabolic Disorder; Stomach