Abstract
Endoscopic gastric plication or gastroplasty for morbid obesity is gaining worldwide recognition. Data concerning safety and efficacy are rather scarce. Furthermore, clear guidelines are yet to be established. The objective of this meta-analysis is to update the data and investigate the efficacy and safety of the procedure. An online comprehensive search using Cochrane, Google Scholar, PubMed, Web of Science, and Embase on endoscopic gastric plication was completed. The primary outcome was defined as weight loss at 6 months or more after the procedure. Secondary outcomes were defined as the occurrence of adverse events or complications including insufficient weight loss or regain. I2 statistic was used to define the heterogeneity across studies. Twenty-two cohort studies on 7 different devices met the inclusion criteria, with a total of 2475 patients. The mean baseline BMI was 37.8 ± 4.1 kg/m2 (median 37.9; range 28.0–60.2). Either a transoral endoluminal stapling or (suction based) (full-thickness) stitching and/or anchor device was used to obtain gastric volume reduction and/or alter gastric outlet. The mean follow-up was 13 months (median 12; range 6–24) for the specified outcomes of each study. Two active, FDA-approved devices were taken into account for meta-analysis: Endoscopic sleeve gastroplasty (ESG) and the primary obesity surgery endolumenal (POSE™). Average pooled %EWL at 6 months (p = 0.02) and 12 months (p = 0.04) in favor of ESG was 57.9 ± 3.8% (50.5–65.5, I2 = 0.0), 44.4 ± 2.1% (40.2–48.5, I2 = 0.0), and 68.3 ± 3.8% (60.9–75.7, I2 = 5.8), 44.9 ± 2.1% (40.9–49.0, I2 = N/A) for ESG and POSE respectively. Major adverse events without mortality were described in 25 patients (9 studies, p = 0.63). ESG and POSE are both safe and feasible procedures with good short-term weight loss. ESG seems to be superior in terms of weight loss at this point. Few major adverse events are reported and long-term results are awaited.
Similar content being viewed by others
References
018 WHO fact sheets obesity and overweight. http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55.
Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis. 2017;13(2):170–80.
Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255–65.
Devière J, Ojeda Valdes G, Cuevas Herrera L, et al. Safety, feasibility and weight loss after transoral gastroplasty: first human multicenter study. Surg Endosc. 2008;22(3):589–98.
Familiari P, Costamagna G, Bléro D, et al. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome. Gastrointest Endosc. 2011;74(6):1248–58.
Moreno C, Closset J, Dugardeyn S, et al. Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study. Endoscopy. 2008;40(5):406–13.
Nanni G, Familiari P, Mor A, et al. Effectiveness of the Transoral Endoscopic Vertical Gastroplasty (TOGa®): a good balance between weight loss and complications, if compared with gastric bypass and biliopancreatic diversion. Obes Surg. 2012;22(12):1897–902.
Schiefke I, Zabel-Langhennig A, Neumann S, et al. Long term failure of endoscopic gastroplication (EndoCinch). Gut. 2005;54(6):752–8. https://doi.org/10.1136/gut.2004.058354.
Changela K, Ofori E, Duddempudi S, et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: techniques and efficacy. World J Gastrointest Endosc. 2016;8(4):239–43.
Fogel R, De Fogel J, Bonilla Y, et al. Clinical experience of transoral suturing for an endoluminal vertical gastroplasty: 1-year follow-up in 64 patients. Gastrointest Endosc. 2008;68(1):51–8.
Brethauer S, Chand B, Schauer PR, et al. Transoral gastric volume reduction as intervention for weight management: 12-month follow-up of TRIM trial. Surg Obes Relat Dis. 2012;8(3):296–303.
Dayyeh A, Barham K, Acosta A, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol. 2017;15(1):37–43.e1.
Graus Morales J, Crespo Pérez L, Marques A, et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc. 2018;32(9):3936–42.
Kumar N, Abu Dayyeh BK, Lopez-Nava Breviere G, et al. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique. Surg Endosc. 2018;32(4):2159–64.
Lopez-Nava G, Galvão MP, Bautista-Castaño 1 d, et al. Endoscopic sleeve gastroplasty for the treatment of obesity. Endoscopy. 2015;47(5):449–52.
Lopez-Nava G, Sharaiha RZ, Vargas EJ, et al. Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up. Obes Surg. 2017;27(10):2649–55.
Sartoretto A, Sui Z, Hill C. Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study. Obes Surg 2018;28(7):1812–1821.
Sharaiha RZ, Kumta NA, Saumoy M. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol. 2017;15(4):504–10.
Alqahtani A, Al-Darwish A, Mahmoud AE et al. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc 2018 . pii: S0016-5107(18)33363-7.
Espinós JC, Turró R, Mata A, et al. Early experience with the incisionless operating PlatformTM (IOP) for the treatment of obesity: the primary obesity surgery Endolumenal (POSE) procedure. Obes Surg. 2013;23(9):1375–83.
Espinós JC, Turró R, Moragas G, et al. Gastrointestinal physiological changes and their relationship to weight loss following the POSE procedure. Obes Surg. 2016;26(5):1081–97.
López-Nava G, Bautista-Castaño I, Jimenez A, et al. The Primary Obesity Surgery Endolumenal (POSE) procedure: one-year patient weight loss and safety outcomes. Surg Obes Relat Dis. 2015;11(4):861–5.
Miller K, Turró R, Greve JW. MILEPOST multicenter randomized controlled trial: 12-month weight loss and satiety outcomes after pose SM vs. medical therapy. Obes Surg. 2017;27(2):310–22.
Sullivan S, Swain JM, Woodman G, et al. Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: the ESSENTIAL trial. Obesity (Silver Spring). 2017;25(2):294–301.
Verlaan T, Paulus GF, Mathus-Vliegen EM. Endoscopic gastric volume reduction with a novel articulating plication device is safe and effective in the treatment of obesity (with video). Gastrointest Endosc. 2015;81(2):312–20.
Huberty V, Ibrahim M, Hiernaux M, et al. Safety and feasibility of an endoluminal-suturing device for endoscopic gastric reduction (with video). Gastrointest Endosc. 2017;85(4):833–7.
Huberty V, Machytka E, Boškoski I, et al. Endoscopic gastric reduction with an endoluminal suturing device: a multicenter prospective trial with 1-year follow-up. Endoscopy. 2018;50(12):1156–62.
Seeras K, Prakash S. Laparoscopic Lap Band Placement. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan–2018 Jul 29.
Palermo MM, Acquafresca PA, Rogula T, et al. Late surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig. 2015;28(2):139–43.
Kumar N, Thompson CC. Comparison of a superficial suturing device with a full-thickness suturing device for transoral outlet reduction (with videos). Gastrointest Endosc. 2014;79(6):984–9.
Khan Z, Khan MA, Hajifathalian K, et al. Efficacy of endoscopic interventions for the management of obesity: a meta-analysis to compare endoscopic sleeve gastroplasty, AspireAssist, and primary obesity surgery endolumenal. Obes Surg. 2019;29:2287–98. https://doi.org/10.1007/s11695-019-03865-w.
Novikov AA, Afaneh C, Saumoy M, et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: how do they compare? J Gastrointest Surg. 2018;22(2):267–73.
Itlaybah A, Elbanna H, Emile S, et al. Correlation between the number of ghrelin-secreting cells in the gastric fundus and excess weight loss after sleeve gastrectomy. Obes Surg. 2018;29:76–83. https://doi.org/10.1007/s11695-018-3498-z.
Stimac D, Majanović SK. Endoscopic approaches to obesity. Dig Dis. 2012;30:187–95.
Rogers CA, Reeves BC, Byrne J, et al. Adaptation of the By-Band randomized clinical trial to By-Band-Sleeve to include a new intervention and maintain relevance of the study to practice. La Br J Surg. 2017;104(9):1207–14.
Kourkoulos M, Giorgakis E, ,Kokkinos C et al. Laparoscopic gastric plication for the treatment of morbid obesity: a review. Minim Invasive Surg 2012;2012:696348.
Grubnik VV, Ospanov OB, Namaeva KA, et al. Randomized controlled trial comparing laparoscopic greater curvature plication versus laparoscopic sleeve gastrectomy. Surg Endosc. 2016;30(6):2186–91.
Ye Q, Chen Y, Zhan X, et al. Comparison of laparoscopic sleeve gastrectomy and laparoscopic greater curvature plication regarding efficacy and safety: a meta-analysis. Obes Surg. 2017;27(5):1358–64.
Barrichello S, Minata MK, García Ruiz de Gordejuela A et al. Laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy treatments for obesity: systematic review and meta-analysis of short- and mid-term results. Obes Surg 2018;28(10):3199–3212.
De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96.
Ryou M, Ryan MB, Thompson CC. Current status of endoluminal bariatric procedures for primary and revision indications. Gastrointest Endosc Clin N Am. 2011;21(2):315–33.
Kumta NA, Doshi R, Aronne LJ, et al. Trimming the fat: endoscopic suturing for tightening of prior endoscopic sleeve gastroplasty. Gastrointest Endosc. 2017;85(1):253–25.
Schweitzer M. Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients. J Laparoendosc Adv Surg Tech A. 2004;14(4):223–6.
Brunaldi VO, Jirapinyo P, de Moura DTH, et al. Endoscopic treatment of weight regain following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg. 2018;28(1):266–76.
Goyal V, Holover S, Garber S, et al. Gastric pouch reduction using StomaphyX in post Roux-en-Y gastric bypass patients does not result in sustained weight loss: a retrospective analysis. Surg Endosc. 2013;27(9):3417–20.
Sczepaniak JP, Owens ML, Shukla H, et al. Comparability of weight loss reporting after gastric bypass and sleeve gastrectomy using BOLD data 2008-2011. Obes Surg. 2015;25(5):788–95.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix I Syntaxes used for the search in the different available databases
Appendix I Syntaxes used for the search in the different available databases
exp. endoscopic sleeve gastroplasty/co, di, dm, dt, ep, et, pc, si, su, th [Complication, Diagnosis, Disease Management, Drug Therapy, Epidemiology, Etiology, Prevention, Side Effect, Surgery, Therapy]
Cochrane
MeSH descriptor: [Gastroplasty] explode all trees
Web of science
TS = (endoscopic AND gastroplasty)
PubMed publisher
“Endoscopy”[Mesh] AND “Gastroplasty”[Mesh]
Google scholar
allintitle: “endoscopic” and “gastroplasty”
Rights and permissions
About this article
Cite this article
Gys, B., Plaeke, P., Lamme, B. et al. Endoscopic Gastric Plication for Morbid Obesity: a Systematic Review and Meta-analysis of Published Data over Time. OBES SURG 29, 3021–3029 (2019). https://doi.org/10.1007/s11695-019-04010-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-019-04010-3