P2766 - Effects of Stomach Shortening on Weight Loss Following Endoscopic Sleeve Gastroplasty

Monday, October 23, 2023

10:30 AM – 4:15 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

DI

Danny Issa, MD

UCLA
Los Angeles, CA

Award: Presidential Poster Award

Philip Kozan, MD¹, Firas Bahdi, MD², Maryam Farooq, MSEd², Fadi Dahoud, BSc², Sagar Shah, MD¹, V. Raman Muthusamy, MD, MAS¹, Danny Issa, MD¹
¹UCLA, Los Angeles, CA; ²David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA

Introduction: Endoscopic sleeve gastroplasty (ESG) is a restrictive procedure that leads to significant total body weight loss (TBWL) by remodeling the stomach and reducing gastric volume. Although ESG is very effective, the rates of TBWL vary between patients. No prior data is available on the impact of stomach length reduction as a predictive factor for weight loss. Therefore, we aimed to evaluate if the shortening of the sleeve is correlated to weight loss in patients undergoing ESG.

Methods: This was a prospective study of adult patients undergoing endoscopic bariatric therapy between 06/2021 and 03/2023 for primary treatment of morbid obesity at an academic medical center. The length of the sleeve was measured before and after gastroplasty. The initial length before gastroplasty was adjusted for scope looping in the fundus using a 12% relative reduction of the gastroesophageal junction-to-pylorus distance. The primary outcome was the correlation between the length of sleeve reduction and the amount of weight lost.

Results: Twenty-four adult patients with obesity were included in the study. All patients tolerated ESG well, with no significant adverse events. Two patients underwent repeat ESG for weight regain at one year. Mean %TBWL at 3, 6, and 12 months were 21.6±18.1, 18.2±16.9, and 12.6±18.7, respectively (Table). Among the 24 included patients, sixteen completed six months, and eight completed 12 months of follow-up after ESG. No significant correlation was found between %TBWL or mean excessive weight loss and stomach length reduction at three (R = 0.11, P =0.69), six (R = 0.38; P = 0.2), or 12 months (R = 0.33; P = 0.42). The average stomach length reduction was not significantly different between patients who had ≥10% TBWL vs. < 10% TBWL, Figure 1, (10.6±6.8 vs. 14.5±6.1 cm, respectively; P=0.25).

Discussion: No significant correlation was found between stomach shortening and the percentage of weight loss following ESG in our cohort. These data suggest that the mechanism of action and efficacy of gastroplasty are unlikely dependent on sleeve length. Further study is needed to validate these findings.

Figure: The figure displays the average stomach length resduction (cm) for patients with greater than 10% total body weight loss (TBWL) and patients with less than 10% TBWL.

Main Demographic and Clinical Characteristics
N=24
Age, years 46 ± 12.2
Gender, Female n(%) 18 (75)
BMI at baseline (lbs/feet²±SD) 39.6 ± 7.5
TBWL (mean±SD)
3 months 21.6 ± 18.1
6 months 18.2 ± 16.9
12 months 12.6 ± 18.7
BMI loss (lbs/feet²±SD)
3 months 5.6 ± 9.3
6 months 2.9 ± 2.8
12 months 1.9 ± 3.3
Total patients on follow up, to date (n) 24
3 month follow up 16
6 month follow up 13
12 month follow up 8
Outcomes Per Weight Loss Groups
Weight loss groups (n) TBWL ≥ 10% TWBL < 10% P value
N=8 N=8
Age (avg±SD) 48.4 ± 14.3 45.8 ± 13.3 0.4
Gender, n (%) 0.2
Female 5 (62.5) 7 (87.5)
Male 3 (37.5) 1 (12.5)
Race, n (%) 0.9
White 7 (87.5) 6 (75)
American Indian 0 1 (12.5)
Unknown 1 (12.5) 1 (12.5)
BMI Baseline (mean±SD) 41.4 ± 5.9 38.3 ± 5.9 0.27
Sutures (n±SD) 8.4 ± 2.7 8.5 ± 3.4 0.1
Effects of Stomach Shortening on Weight Loss
Stomach Length Before ESG, mean (cm±SD) 30.3 ± 6.5 29.7 ± 6.8 0.16
Stomach Length After ESG*, mean (cm±SD) 19.6 ± 4.8 15.2 ± 3.3 0.05
Stomach Length Reduction, mean (cm±SD) 10.6 ± 6.8 14.5 ± 6.1 0.25

Main Demographic and Clinical Characteristics
	N=24
Age, years	46 ± 12.2
Gender, Female n(%)	18 (75)
BMI at baseline (lbs/feet²±SD)	39.6 ± 7.5
TBWL (mean±SD)
3 months	21.6 ± 18.1
6 months	18.2 ± 16.9
12 months	12.6 ± 18.7
BMI loss (lbs/feet²±SD)
3 months	5.6 ± 9.3
6 months	2.9 ± 2.8
12 months	1.9 ± 3.3
Total patients on follow up, to date (n)	24
3 month follow up	16
6 month follow up	13
12 month follow up	8
Outcomes Per Weight Loss Groups
Weight loss groups (n)	*TBWL ≥ 10%*	*TWBL < 10%*	*P value*
	N=8	N=8
Age (avg±SD)	48.4 ± 14.3	45.8 ± 13.3	0.4
Gender, n (%)			0.2
Female	5 (62.5)	7 (87.5)
Male	3 (37.5)	1 (12.5)
Race, n (%)			0.9
White	7 (87.5)	6 (75)
American Indian	0	1 (12.5)
Unknown	1 (12.5)	1 (12.5)
BMI Baseline (mean±SD)	41.4 ± 5.9	38.3 ± 5.9	0.27
Sutures (n±SD)	8.4 ± 2.7	8.5 ± 3.4	0.1
Effects of Stomach Shortening on Weight Loss
Stomach Length Before ESG, mean (cm±SD)	30.3 ± 6.5	29.7 ± 6.8	0.16
Stomach Length After ESG*, mean (cm±SD)	19.6 ± 4.8	15.2 ± 3.3	0.05
Stomach Length Reduction, mean (cm±SD)	10.6 ± 6.8	14.5 ± 6.1	0.25

Disclosures:

Philip Kozan indicated no relevant financial relationships.

Firas Bahdi indicated no relevant financial relationships.

Maryam Farooq indicated no relevant financial relationships.

Fadi Dahoud indicated no relevant financial relationships.

Sagar Shah indicated no relevant financial relationships.

V. Raman Muthusamy: Boston Scientific – Consultant, Grant/Research Support. Capsovision – Stock Options. Endogastric Solutions – Advisory Committee/Board Member. Motus GI – Advisory Committee/Board Member.

Danny Issa indicated no relevant financial relationships.

Philip Kozan, MD¹, Firas Bahdi, MD², Maryam Farooq, MSEd², Fadi Dahoud, BSc², Sagar Shah, MD¹, V. Raman Muthusamy, MD, MAS¹, Danny Issa, MD¹. P2766 - Effects of Stomach Shortening on Weight Loss Following Endoscopic Sleeve Gastroplasty, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.