Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2019; 11(5): 322-328
Published online May 16, 2019. doi: 10.4253/wjge.v11.i5.322
Endoscopic sleeve gastroplasty: From whence we came and where we are going
Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura, Christopher C Thompson
Diogo Turiani Hourneaux de Moura, Christopher C Thompson, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura, Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-00, Brazil
Author contributions: de Moura DTH and de Moura EGH conceptualized the study and wrote the manuscript. Thompson CC critical final review of manuscript/English review.
Conflict-of-interest statement: de Moura EGH consultant for Boston Scientific and Olympus, de Moura EGH is a consultant to Boston Scientific. Thompson CC reports fee as a consultant for Boston Scientific and Medtronic; fees as consultant and institutional grants from USGE Medical, Olympus, and Apollo Endosurgery. All other authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Diogo Turiani Hourneaux de Moura, MD, MSc, PhD, Academic Fellow, Postdoctoral Fellow, Research Fellow, Surgeon, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis St, Boston, MA 02115, United States. dthmoura@hotmail.com
Telephone: +1-857-2509586
Received: March 11, 2019
Peer-review started: March 12, 2019
First decision: April 13, 2019
Revised: April 16, 2019
Accepted: April 18, 2019
Article in press: April 19, 2019
Published online: May 16, 2019
Abstract

The most effective and durable treatment for obesity is bariatric surgery. However, less than 2% of eligible patients who fulfill the criteria for bariatric surgery undergo the procedure. As a result, there is a drive to develop less invasive therapies to combat obesity. Endoscopic bariatric therapies (EBT) for weight loss are important since they are more effective than pharmacological treatments and lifestyle changes and present lower adverse event rates compared to bariatric surgery. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive EBT that involves remodeling of the greater curvature. ESG demonstrated favorable outcomes in several centers, with up to 20.9% total body weight loss and 60.4% excess weight loss (EWL) on 2-year follow-up, with a low rate of severe adverse events (SAE). As such, it could be considered safe and effective in light of ASGE/ASMBS thresholds of > 25% EWL and ≤ 5% SAE, although there are no comparative trials to support this. Additionally, ESG showed improvement in diabetes mellitus type 2, hypertension, and other obesity-related comorbidities. As this procedure continues to develop there are several areas that can be addressed to improve outcomes, including device improvements, technique standardization, patient selection, personalized medicine, combination therapies, and training standardization. In this editorial we discuss the origins of the ESG, current data, and future developments.

Keywords: Endoscopy, Surgery, Bariatric, Obesity, Overweight, Comorbidities, Gastroplasty, Sleeve, Endoscopic sleeve gastroplasty, Editorial

Core tip: Given the worsening obesity epidemic, there is increased demand for less invasive therapies. Considering the minimally invasive nature of Endoscopic sleeve gastroplasty (ESG), the reproducibility among centers, the favorable clinical outcomes in several studies, ESG could be regarded as safe and effective in light of ASGE/ASMBS thresholds of > 25% excess weight loss and ≤ 5% severe adverse events, although there are no comparative trials to support this. As this procedure is more widely adopted, high standards of care must be maintained to guarantee satisfactory clinical outcomes. In this editorial we discuss the origins of the ESG, current data, and future developments.