Claudio Fiorillo1, Giuseppe Quero1, Michel Vix2, Ludovica Guerriero1, Deborah Kadoche2, Pietro Mascagni1, Antonio D’urso2, Didier Mutter2, Jacques Marescaux3, Silvana Perretta3. 1IHU -Strasbourg, 2NHC University Hospital of Strasbourg, 3IRCAD-Strasbourg
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure. Endoscopic sleeve gastroplasty (ESG) is a promising new bariatric endoscopic procedure. While the effects of both techniques have been expressed in excess weight loss (EWL) or comorbidity reduction, to date no study has compared quality of life (QoL) outcomes in patients undergoing LSG versus ESG.
METHODS AND PROCEDURES: A total of 84 ESG and 99 LSG were performed between October 2016 and July 2018 at a single institution. QoL was evaluated by means of Gastrointestinal Quality of Life (GIQLI) questionnaire before and six months after the procedure. Only patients with at least six months of follow-up were included. Patients were matched for age, sex, preoperative weight and comorbidities.
RESULTS: Propensity score matching resulted in 23 pairs of patients homogeneous for age (39.1±9.1 vs 35.5±10 years; p:0.2), weight before surgery (115.5±29.6 vs 119.7±17.4kg; p:0.53), sex (30.4% vs 26.1% males; p:0.74) and comorbidities (60.9 % vs 60.9%; p:0.9). Post-ESG patients despite a less important EWL (27.2±26.3kg vs 58.6±17.8kg; p<0.001), presented a better QoL (12.7±19.5 vs 11.3±15 ΔGIQLI score; p:0.79) with a clear advantage for the gastrointestinal symptoms subdomain (65.4±61 vs 58.5±5.9; p:0.001) (Figure1) while post-LSG patients presented a worsening of GERD symptoms (30.4% vs 0%) and an increased use of PPI therapy (p:0.004). Resolution or improvement of comorbidities was similar (ESG 50% vs LSG 57%; p:0.3) in both groups.
DISCUSSION: The effectiveness of LSG in terms of EWL is well established, however, LSG may significantly affect QoL and result in worsening of gastrointestinal symptoms including GERD. ESG is a promising bariatric endoscopic procedure that demonstrated a positive impact on both quality of life and comorbidities with the potential to reach a greater number of obese patients, earlier in their disease or at a younger age. Larger studies with longer follow-up are needed.
Table 1 QoL Comparison between ESG and LSG
Figure 1 GIQLI score comparison
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95174
Program Number: S126
Presentation Session: Bariatric IV – Quality and Outcomes
Presentation Type: Podium