ESG – a safe and effective procedure

Endoscopic sleeve gastroplasty (ESG) is no longer an experimental procedure and is a safe, effective minimally-invasive treatment option for obesity, the Irish Society of Gastroenterology Winter Meeting 2023 heard from an Irish pioneer in its usage.

Mr Jamie Kelly, Bariatric and Cancer Surgeon, Spire Southampton Hospital, UK, discussed the development of the procedure and the advancing evidence-base.

In ESG, the surgeon uses a suturing device attached to the endoscope to perform full-thickness stitching of the stomach to reduce gastric capacity and delay emptying. The folds of the stomach are pulled together, accordion-style, which creates a sleeve-like shape under a third of its original size. This leads to the patient losing a substantial amount of weight as they become fuller faster and for longer after eating.

“This is categorically not a physical barrier to someone overeating. I cannot stress that enough; this is turbocharging normal physiology so that they feel full quickly and can use that to portion control,” he explained.

A major benefit of ESG is that patients experience a faster recovery time and lower post-operative risks, both incidence rate and severity, compared to other weight-loss procedures and it is potentially reversible, if necessary, Mr Kelly explained.

“As the evidence has developed and the safety profile has been established, we can now use the procedure in a much bigger BMI range than we expected to… it is now a well-established procedure with over 15,000 cases recorded in the literature [>25,000 surgeries globally], and its safety profile is excellent,” he said, adding that it is a very good option for older patients.

Mr Kelly quoted from the recent MERIT trial, which concluded ESG is a safe intervention that resulted in significant weight loss, maintained at 104 weeks, with important improvements in metabolic comorbidities, and recommended that it be considered as a synergistic weight loss intervention for patients with class 1 or 2 obesity.

ESG was also approved by the National Institute for Health and Care Excellence in the UK earlier this year as a weight-loss option for obesity in the NHS, he noted.

Looking to the future, Mr Kelly predicted wider uptake of ESG and briefly discussed promising early data on the use of GLP-1 inhibitors in conjunction with ESG to treat obesity.