Outcomes of ESG and LSG with 12+ Months of Adjuvant Pre- and Postoperative Multidisciplinary Support

Background:
Adults with obesity are electing bariatric procedures
including the laparoscopic sleeve gastrectomy (LSG) and more
recently, the incisionless endoscopic sleeve gastroplasty (ESG).
However, their efficacy, safety and patient-centered outcomes re-
quire further investigation in the Australian setting. To examine the
6- and 12-month weight loss efficacy, safety, and weight-related
quality of life (QoL) of adults with obesity who received the ESG
or LSG bariatric procedure with 12+ months of adjuvant multidisci-
plinary pre- and postoperative support.

Methods:
Two-arm prospective cohort study followed Australian
patients who elected the ESG or LSG procedure from baseline to
12-months postoperative. Excess weight loss (EWL) was the primary
outcome. Secondary outcomes were body composition via dual en-
ergy X-ray absorptiometry, weight-related QoL, lipid, glycemic, and
hepatic biochemistry, and adverse events.

Results:
16 (81.2% female; aged 41.4 (SD = 10.4)years; BMI = 35.5 (SD
= 5.2)kg/m2) ESG and 45 (84.4% female; aged 40.4 (9.0)years; BMI =
40.7 (5.6)kg/m2) LSG participants were recruited. At 12-months post-
procedure, ESG EWL was 57% (SD: 32%; p < 0.01) and LSG EWL was
79% (SD: 24; p < 0.001). ESG and LSG cohorts improved QoL, liver
function, and lipid profiles; however, only LSG was statistically signif-
icant (p < 0.001). Both cohorts reduced fat mass (p < 0.05). The ESG
maintained but LSG decreased fat free mass at 6-months (p < 0.05). No
procedure-related serious adverse events were identified.

Conclusions:
In this setting, the ESG and LSG were safe and effective
weight loss treatments for obese adults alongside multidisciplinary sup-
port. The ESG may confer additional benefits in the retention of fat free
mass whilst LSG may lead to greater overall (fat and fat-free mass) weight
loss. Further well powered studies are required to confirm these findings.