Endoscopic sleeve gastroplasty (ESG) is safe and effective in elderly patients with obesity who are unable to lose weight with non-invasive methods and who refuse or are unsuitable for bariatric surgery because of age and comorbidities, according to a small study by Italian researchers. The outcomes were featured in the paper, ‘Outcomes of Endoscopic Sleeve Gastroplasty in the Elder Population’, published in Obesity Surgery.
Although there are approximately 250 publications and abstracts reporting outcomes in over 10,000 individual patients undergoing ESG procedures1, the paper’s authors stated to their knowledge there are no published studies evaluating bariatric endoscopy in the elderly with morbid obesity. This is despite that given the minimally invasiveness of ESG, the procedure may provide an option for elder patients excluded from bariatric surgery. Therefore, they analysed the short- and medium-term outcomes of ESG performed in older patients with obesity treated with ESG at the Digestive Endoscopy Unit of Fondazione Policlinico Universitario A Gemelli IRCCS, in Rome, Italy.
In total, 271 patients underwent ESG from November 2017 to July 2021 and 18 patients were 65 years of age or older. Ten of the elderly patients were excluded from bariatric surgery due to excessive risk according to the multidisciplinary team and eight patients were deemed fit for surgery but refused it.
After multidisciplinary evaluation, 18 patients underwent ESG. There were no peri-procedural or post-procedural adverse events and there were no reported episodes of vomiting, gastroesophageal reflux symptoms or dysphagia. All patients were discharged within 24–48 hours after the procedure.
EWL% at six and 24 months was 39% and 41%, respectively, and TBWL% was 15.1% and 15.5%, respectively. In comparison, patients under 65 (n=253) reported TBWL% of 15.5% and 15.5 at 12 and 24 months, respectively. One patient was lost at follow-up and five patients have yet to reach 24 months of follow-up.
Six out of 12 patients with arterial hypertension experienced improvements in blood pressure values within 12 months four reduced and two suspended antihypertensive drugs. From the six patients with OSA, two stopped continuous positive pressure equipment) within 12 months. Three of the four diabetic patients had an improvement in blood glucose and stopped antidiabetic medications. The median Bariatric Analysis and Reporting Outcome System score was 3.0, 3.4, and 2.5 at six, 12, and 24 months, respectively.
“A multidisciplinary evaluation is mandatory in both patient selection and follow-up, to build a comprehensive and dynamic support to promote weight loss, especially in the elderly who are less physically active, have a lower ability to modify eating and behavioural habits, and have a higher rate of comorbidities,” the authors concluded. “Future prospective and larger studies are necessary to further understand the therapeutic role of ESG in the elderly with obesity.”
Apollo Endosurgery internal meta-analysis of published ESG studies
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