Big News! IFSO Endorsed ESG!

As obesity rates continue to rise worldwide, the medical community is increasingly focusing on finding effective, minimally invasive solutions for weight management. Traditional surgical approaches, while effective, are not suitable for everyone due to the risks, recovery times, and certain health requirements. To bridge this gap, Endoscopic Sleeve Gastroplasty (ESG) has emerged as a promising option for those looking for less invasive weight-loss procedures.

Recently, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) endorsed ESG as an effective method for managing obesity, especially for patients who cannot or prefer not to undergo traditional surgery. This endorsement follows a comprehensive review of ESG, reflecting its rising acceptance as a valuable addition to obesity care. Let’s dive into what ESG is, why it’s significant, and how the IFSO’s review supports its role in obesity treatment.

What is Endoscopic Sleeve Gastroplasty (ESG)?

ESG is a minimally invasive, endoscopic procedure designed to reduce the stomach’s volume, limiting food intake and helping individuals lose weight. Unlike traditional bariatric surgery, ESG does not require any cuts or large incisions. Instead, the procedure is performed using an endoscope—a flexible tube equipped with a camera and suturing device—that enters the stomach through the mouth.

Once inside the stomach, the surgeon uses specialized tools to create a series of sutures along the stomach wall, reducing its overall size and forming a sleeve-like structure. This reshaping of the stomach reduces the amount it can hold, helping patients feel full after consuming smaller portions of food. Since ESG preserves the natural anatomy of the digestive system, it also reduces the risks associated with more invasive surgeries.

The IFSO Review and Endorsement of ESG

The recent endorsement of ESG by IFSO is based on a systematic review conducted by the IFSO Bariatric Endoscopy Committee. This review collected and analyzed data from various studies on ESG, with the aim of evaluating its safety, effectiveness, and role within obesity care. The review included findings from numerous case studies, cohort studies, and even a randomized controlled trial, encompassing a total of over 15,000 patients.

The review’s findings provided evidence supporting ESG as a valuable option for weight loss, particularly for individuals with obesity who either cannot undergo or choose not to have more invasive procedures. Here are some of the key findings and conclusions from this IFSO-backed review:

1. Significant Weight Loss Outcomes: The review found that ESG led to meaningful and sustained weight loss across different study groups. Patients generally experienced a significant percentage of excess weight loss (EWL) and total body weight loss (TBWL) over periods extending up to five years. For example, average TBWL values remained between 14-18% over 24 to 36 months, indicating durable results.

2. Safety Profile: The review demonstrated that ESG has a favorable safety profile, with a serious adverse event rate of only 1.25%. This low rate of complications underscores ESG’s position as a safer alternative to more invasive weight-loss surgeries, especially for patients who might have higher surgical risks.

3. Quality of Evidence: Although most of the studies included in the review were observational, limiting the level of evidence, the findings from a randomized controlled trial (RCT) included in the review offered more robust support for ESG’s efficacy and safety. The RCT reinforced ESG’s status as a reliable option for weight management, providing a higher level of scientific evidence to back the positive outcomes observed in other study types.

Why ESG is an Important Development in Obesity Treatment

The IFSO’s endorsement of ESG signals a shift toward accepting less invasive methods as part of mainstream obesity treatment. Here’s why ESG’s position in obesity care is so important:

• Alternative for High-Risk Patients: Many patients with obesity have health conditions that make them poor candidates for surgery. ESG provides a viable alternative for these patients, offering significant weight loss without the high risks associated with surgical interventions.

• Options for Those with Lower BMI: Some individuals with a BMI below the threshold for traditional surgery still struggle with obesity-related health conditions, but they may not qualify for traditional metabolic and bariatric surgery (MBS). ESG fills this gap, providing an option for patients with class I and II obesity who may still benefit from medical intervention.

• Reduced Healthcare Burden: Because ESG can often be performed as an outpatient procedure, it reduces the time patients need to spend in healthcare facilities, lowers the risk of complications, and generally has a shorter recovery period compared to surgery. This can help reduce healthcare costs and increase accessibility for patients who need treatment.

Detailed ESG Outcomes from the IFSO Review

The IFSO review looked at weight loss outcomes and complication rates for ESG over time. Here are some of the specific results from the review:

1. Weight Loss:

• 6 Months: Patients typically lost an average of 15.66% of their total body weight.

• 12 Months: At the one-year mark, average weight loss increased to approximately 17.56%.

• 18-24 Months: Patients continued to lose weight over time, with results peaking around 18 months at nearly 16.25%.

• Long-Term Results: Even at 36 to 60 months, weight loss remained stable, with mean weight loss percentages staying between 14-15%.

2. Safety and Complications:

• The review showed that serious complications were uncommon, with a rate of only 1.25%.

• Mild side effects, such as nausea or abdominal discomfort, were more common but generally resolved quickly.

3. Quality of Evidence:

• While observational studies were the primary source of data, a single RCT in the review provided a more moderate level of evidence for ESG’s safety and effectiveness. The RCT’s findings aligned with those of other studies, reinforcing the reliability of ESG as a weight-loss tool.

How ESG Compares to Other Weight-Loss Procedures

Compared to traditional bariatric surgeries like the gastric bypass or sleeve gastrectomy, ESG offers several distinct advantages:

• Lower Risk: ESG has a much lower rate of complications than many traditional surgeries, as it doesn’t involve cutting or stapling parts of the stomach or intestines.

• Quicker Recovery: Most patients can return to daily activities within a few days after ESG, whereas recovery from surgical options can take several weeks.

• Reversibility: While not commonly reversed, ESG is theoretically reversible by removing the stitches, which is not an option with more permanent procedures like sleeve gastrectomy.

However, ESG may also have limitations in comparison to traditional surgeries:

• Less Drastic Weight Loss: While ESG is effective, the amount of weight loss may be slightly less than with traditional surgeries, especially for those with higher BMI levels.

The Future of ESG in Obesity Management

The IFSO endorsement of ESG is a pivotal development in the field of obesity treatment, as it highlights the potential for ESG to become a standard, widely accepted option within the broader spectrum of obesity care. As more studies are conducted, and additional RCTs build upon the existing data, the medical community will gain an even clearer picture of ESG’s long-term benefits and limitations.

The IFSO’s endorsement encourages healthcare providers to consider ESG not as an alternative to surgery but as a complementary option. It opens up the possibility of using ESG as part of a multidisciplinary obesity treatment plan, giving doctors more tools to help patients achieve sustainable weight loss.

Key Takeaways for Patients Considering ESG

If you’re considering ESG as a weight-loss option, here are some essential points to discuss with your healthcare provider:

1. Eligibility: ESG is best suited for patients with a BMI between 30 and 40 who haven’t found success with diet and exercise alone.

2. Expected Outcomes: ESG offers significant weight loss, but results vary. Your doctor can help you set realistic goals based on your health profile.

3. Risks and Recovery: While ESG has a favorable safety profile, mild side effects are possible. Be sure to follow all post-procedure care instructions to minimize risks.

4. Commitment to Lifestyle Changes: Like all weight-loss procedures, ESG requires a commitment to healthy eating, exercise, and regular medical follow-up for the best long-term results.

Conclusion

The IFSO’s endorsement of Endoscopic Sleeve Gastroplasty marks an important step forward in making effective, minimally invasive obesity treatments more accessible. ESG fills a critical gap for patients who cannot or prefer not to undergo traditional surgery, offering a safe and effective way to achieve lasting weight loss.

As the global health community faces rising rates of obesity, tools like ESG provide new hope. Backed by comprehensive evidence and the support of an influential organization like the IFSO, ESG is well on its way to becoming a cornerstone of obesity management. 

Source:IFSO Position Statement