Does endoscopic mean safer? A comparison of the short-term safety of endoscopic versus laparoscopic bariatric therapies

Endoscopic Sleeve Gastroplasty (ESG) Versus Laparoscopic Sleeve Gastroplasty (LSG): A Comparative Review

Obesity is one of the most debilitating conditions. In a quest to mitigate disease severity, various interventions have been proposed, with endoscopic sleeve gastroplasty (ESG) and laparoscopic sleeve gastroplasty (LSG) being among the recent interventions that have received growing attention. This systematic review sought to conduct a comparative analysis regarding the efficacy, effectiveness, and safety of both interventions. The study involved a systematic review in which key search engines were used to select articles documented and published in the last decade. The articles for inclusion were those existing as peer-reviewed studies touching upon the aforementioned subject, with both controlled and uncontrolled trials included. Furthermore, there was the implementation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol that governs systematic reviews, in which the article selection process entailed four key procedures in the form of identification, screening, determining eligibility, and the inclusion process. In the findings, the selected articles documented mixed outcomes, but a common denominator was that the safety profile of ESG tends to be superior to that of LSG due to the observations that ESG comes with fewer adverse events such as gastroesophageal reflux disease (GERD) and severe nausea and vomiting. However, the majority of the studies contended that LSG proved superior to ESG in terms of effectiveness and efficacy. Hence, individuals with mild-to-moderate obesity are more likely to benefit from ESG, but those with severe obesity whose goal is to achieve long-term weight management might benefit more from LSG. In conclusion, the management of obesity and the decision to employ ESG or LSG ought to be patient-centered and dictated by factors such as patient preferences, safety, and the sustainability of the devised plan of care.

Perception of Bariatric Surgery and Endoscopic Bariatric Therapies Among Primary Care Physicians

INTRODUCTION

In the USA, less than 1% of eligible patients who qualify for bariatric surgery ultimately undergo surgery. Perceptions of endoscopic bariatric therapies (EBTs) for weight management remain unknown.

METHODS

A 22-question survey was distributed to primary care physicians (PCPs) across the Mayo Clinic healthcare system. Survey invitations were sent via email, and all surveys were unanimously conducted electronically.

RESULTS

A total of 130 PCPs participated in the survey (40% response rate). Twenty-four PCPs were between 20 and 24 years out of training (18.5%), and 71 (54.6%) were female. Most providers had a body mass index (BMI) between 18.5 and 24.9 kg/m² (n = 62, 47.7%). Among the weight loss options discussed during clinic visits, PCPs discussed lifestyle modification including diet and exercise (n = 129; 99.2%), and 68 PCPs (52.3%) were not aware of EBTs as weight loss interventions. While 46.2% of the PCPs agreed that a bariatric endoscopy is an effective option for weight loss, only 24.6% of PCPs were familiar with the indications for EBTs. Most of the cohort (n = 69, 53.1%) experienced barriers in referring their patients. Moreover, most of the patients referred to bariatric clinics were from PCPs who had a BMI between 18.5 and 24.9 kg/m² (n = 62, 47.7%) as compared to PCPs with a BMI of 40 kg/m² and greater (n = 5, 3.8%).

CONCLUSIONS

Due to the rise of bariatric therapies in recent years, PCPs are increasingly involved in the referral and management of patients with obesity and obesity-related comorbidities. However, knowledge gaps regarding weight loss options, including EBTs, could limit optimal care to patients desiring medically monitored weight loss.