Advancing Obesity Treatment with Endoscopic Sleeve Gastroplasty

Introduction:

Because of the introduction of a new treatment known as endoscopic sleeve gastroplasty (ESG), there has been a substantial change in the fight against obesity, which is a concern for the healthcare sector all over the world. The National Institute for Health and Care Excellence (NICE) has recently published a comprehensive literature review of the fundamental principles, benefits, and considerations associated with this new technique.

Understanding Obesity:

Although there is no clear definition, obesity is typically characterised by a body mass index (BMI) of 30 kg/m2 or above. There are a wide variety of health concerns that are linked to obesity, such as type 2 diabetes, hypertension, and psychological disorders. Ethnic groups such as South Asian, Chinese, and African-Caribbean are prone to obesity-related complications at a lower BMI threshold of 27.5 kg/m2. This is due to the fact that these populations are more likely to have central obesity. The risk of cardiometabolic disease is also higher at lower BMI. The severity of obesity is categorised as follows:

• obesity class 1 (BMI 30 kg/m2 – 34.9 kg/m2),
• obesity class 2 (BMI 35 kg/m2 – 39.9 kg/m2), and
• obesity class 3 (BMI 40 kg/m2 or more).

Current Treatments for Obesity:

The conventional approach to obesity management involves a combination of dietary advice, exercise, lifestyle changes, and medication. It is suggested that bariatric surgery be performed in severe situations. These surgeries reduce the stomach size or limit its food absorption capacity. Their goal is to decrease the amount of consumed food. Surgical procedures for obesity include laparoscopic gastric banding and sleeve gastrectomy.

The Emergence of Endoscopic Sleeve Gastroplasty:

ESG is a minimally invasive procedure that reduces the stomach’s volume, creating a sensation of fullness and limiting food intake. The procedure, performed under general anaesthesia, involves stitching the stomach’s greater curvature to reduce its volume by 70% to 80%.

The Efficacy and Safety of ESG:

NICE conducted a rapid review of the evidence available which involved a thorough literature search and evidence review from 8 sources. The evidence consisted of 1 randomised controlled trial, 4 systematic reviews, 2 cohort studies, and 1 propensity score matched research. The committee identified key efficacy outcomes as short and long-term weight loss, quality of life, comorbidity improvement, nutritional status, and technical success. The findings indicate that ESG, in combination with lifestyle changes, can effectively aid weight loss for those with a BMI over 30 kg/m2.

Committee Considerations:

The committee highlighted that ESG could be especially advantageous for certain individuals:

• Class 3 obesity patients at high risk for invasive bariatric surgery,
• Those who decline bariatric surgery due to risks and complications,
• Obese individuals (class 1 or 2) who may benefit from the procedure for preventing obesity progression and comorbidities.

Cost effectiveness of ESG

Research in the UK revealed that combining ESG with lifestyle modification (LM) is more cost-effective than just LM in adults with class 2 obesity. The base-case Incremental Cost-Effectiveness Ratio (ICER) stood at £2,453 per Quality Adjusted Life Year (QALY). ESG proved cost-effective at the NICE willingness to pay threshold in all sensitivity analyses. A separate study compared Laparoscopic Sleeve Gastrectomy (LSG) and ESG over 30 days from a US perspective. The findings showed significant cost-savings with ESG. The savings were attributed to a reduction in operation room time and length of hospital stay.

Conclusion:

In conclusion, ESG marks a significant advancement in the treatment of obesity, providing a viable alternative to conventional treatments. The minimally invasive procedure provides a safer approach for high-risk surgical patients or those who refuse invasive bariatric surgery. The evidence NICE reviewed indicates that combining ESG with LM can effectively promote weight loss in individuals with a BMI over 30 kg/m2. Moreover, cost-effectiveness analyses show that ESG is more cost-effective and requires a shorter hospital stay than conventional treatments like lifestyle modification alone or laparoscopic sleeve gastrectomy. However, it is essential to consider that the long-term outcomes and potential complications of ESG are still under study.