Avaliação da eficácia e segurança da gastroplastia endoscópica no manejo de pacientes com obesidade em um seguimento de 12 a 48 meses

Abstract

According to the World Health Organization (WHO), in 2019 2.3 billion people were overweight in the world. In Brazil, overweight already affects 52.5% of adults and such rate increases every year. New alternatives for weight loss have emerged and, among them, endoscopic gastroplasty (ESG), which is an endoscopic procedure that reduces the volume of the stomach through internal sutures. Its use has increased around the world, but the literature with medium and long-term studies is scarce. Objectives and Methods: to evaluate the safety, efficacy and durability of ESG, in a 12 to 48 months (M) monitoring in obese patients. Retrospective singlecenter study with participants who underwent ESG between July 2017 and August 2020. The participants were divided into different groups, with monitoring time ranging from 12 to 48 months, depending on the interval between the procedure and data gathering. All the subjects were at least 18 years old, had a minimum body mass index (BMI) of 30 kg/m2 (grade I obesity) and had not previously undergone bariatric surgery. The study analyzed the variables that can influence the effectiveness and durability of ESG (suture patterns [U versus U + oversuture: “Sander Technique”]), resuture, amount of threads, amount of bites, weight loss (in kilograms), percentage of total body weight loss (% TBWL), percentage of excess weight loss (% EWL), electro-fulguration using argon plasma and monitoring with a nutritionist and a psychologist and the intercurrences and complications, for a period of up to four years after the procedure, within 12 months intervals. Results: a total of 189 patients were analyzed. Regarding safety, there were no complications during the procedures. Mild complications were observed in 7.9% of the patients, in a period of up to 15 days after the procedure, from which 33% were self-limiting gastric bleeding and 67% vomiting. Concerning efficacy, 87.8% of patients obtained more than 10% of %TBWL and more than 25% of %EWL. The average %TBWL was 21.09% and the %EWL was 70.83%. The %TBWL values at each interval were: 16.54% (12M), 20.15% (24M), 19.77% (36M) and 21.09% (48M); and the %EWL was: 56.04% (12M), 69.7% (24M), 70.5% (36M) and 70.8% (48M). The initial average weight was 99.37 kilograms and at the end the average weight was 76.92 kilograms, in the 48-month group. The BMI presented a reduction from 36.08 kg/m2 to 28.66 kg/m2. Regarding durability, at 12 months, 85.1% of the patients evaluated had a tubulized stomach, with fibrosis consolidation between the gastric folds, maintaining the shape that mimics the surgical sleeve, with an endoscopic appearance that suggests a reduction of more than 40% in distensibility and gastric diameter. It was verified that the use of five or more threads, more than 98 bits and the use of the Sander suture technique (U + Oversuture) increases the durability of the ESG. Conclusion: ESG was safe, effective and with good durability, at 12 to 48 months of follow-up. Monitoring with a nutritionist and psychologist had a positive effect concerning weight loss. The Sander technique, using more threads over the U-suture for reinforcement, improved durability and effectiveness over the single U-suture pattern.