Endoscopic Gastroplasty in Obese Patients With a History of Cardiac Revascularization: A Retrospective Study

TL;DR

This study examines the effectiveness of endoscopic gastroplasty for weight loss in obese patients who have had heart surgery, finding it generally safe but less effective for those with prior bariatric surgery or severe obesity.

Contribution

The study provides early evidence on the use of endoscopic gastroplasty in obese patients with a history of cardiac revascularization.

Findings

Endoscopic gastroplasty was well-tolerated with no major adverse events.

Patients with a BMI < 35 achieved better weight loss outcomes compared to those with a BMI > 35.

Patients with prior bariatric surgery failed to achieve significant weight loss after endoscopic gastroplasty.

Abstract

Background

Less invasive endoscopic bariatric procedures are being developed to manage Class I obesity. The most commonly used surgical techniques are laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB), with some cases utilizing adjustable gastric banding (AGB) or biliopancreatic diversion with duodenal switch (BPD-DS). This study aims to assess the efficacy of endoscopic gastroplasty (EG) in obese individuals with metabolic diseases, using an endoscopic suture, along with perioperative care and clinical outcomes over a 12-month follow-up period.

Methods

Eight patients were included in this retrospective study and underwent EG under general anesthesia with overnight hospitalization. We took into consideration elements such as changes in body weight and the occurrence of adverse events. Other studied parameters were demographic (age and sex), clinical (body mass index (BMI) and postoperative clinical manifestations), type of cardiac revascularization (CR), primary obesity or weight regain, and clinical follow-up. EG was recommended as an alternative to surgery due to personal choice or because of the risk of bleeding or cardiovascular events. Patients were divided into two groups to explore the correlation between BMI and potential factors contributing to enhanced weight loss after EG. Group A included four patients with a BMI < 35 and primary obesity or a history of gastric balloon placement, while Group B comprised four patients with a BMI > 35 or a history of bariatric surgery. All patients selected in the study underwent CR procedures prior to EG, such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Results

Endoscopic procedures were performed on eight patients with a mean age of 38.25 years for primary obesity or weight regain. The mean BMI was 34.5 kg/m², with a range between 30.2 and 42.4. No significant adverse events were observed during the endoscopic procedure or in the follow-up period. Seven patients (87.5%) experienced moderate post-procedural pain that lasted for an average of 6.5 days (range: 2-14 days), and five patients experienced nausea and vomiting, which improved with intravenous medications. Of the eight initial patients, seven were available for a three-month follow-up, six for a six-month follow-up, six for a nine-month follow-up, and four completed the 12-month assessment, with a mean excess weight loss (EWL) of 29%. We do not know the motivation for waiving postoperative follow-up except in one case - namely, a change of home address. In accordance with the American Society for Gastrointestinal Endoscopy (ASGE) criteria, two of the four 12-month follow-up patients achieved more than 25% EWL. One patient in Group A achieved successful weight loss with an EWL of 45%, whereas two-thirds of the patients in Group B failed to achieve an EWL greater than 25% at the 12-month follow-up. Additionally, all patients who had previously undergone bariatric surgery failed to achieve any significant weight loss after EG.

Conclusions

EG is a minimally invasive method with good tolerability. However, for patients who have had previous bariatric surgeries or those with severe obesity, the outcomes are suboptimal. Further studies involving larger cohorts and longer follow-up of obese individuals undergoing both CR and EG are needed to generate statistically significant data on post-procedural outcomes.