Effects of Stomach Shortening on Weight Loss Following Endoscopic Sleeve Gastroplasty

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 1 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 1). Among the 24 included patients, sixteen completed 6 months, and 8 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 3 (R = 0.11, P = 0.69), 6 (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). Conclusion: 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 1.: Average stomach length resduction (cm) for patients with greater than 10% total body weight loss (TBWL) and patients with less than 10% TBWL. Table 1. - Main Patients Characteristics and Primary Outcomes 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 LengthAfter 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 ESG, endoscopic sleeve gastroplasty; TBWL, total body weight loss; SD, standard deviation * Adjusted for scope looping in the fundus.