SEMAGLUTIDE IN ASSOCIATION TO ENDOSCOPIC SLEEVE GASTROPLASTY: TAKING ENDOSCOPIC BATRIATRIC PROCEDURES OUTCOMES TO THE NEXT LEVEL
Presentation Number: Su548View Presentation
AuthorBlock: Anna Carolina Hoff1, Sergio Barrichello2, Dilhana Badurdeen3, Vivek Kumbhari3, Manoel Galvao Neto4, Reem Z. Sharaiha5
1bariatric endoscopy, angioskope, Sao Paulo, Sao paulo, Brazil; 2HealthMe, Sao Paulo, SP, Brazil; 3Johns Hopkins University, Baltimore, Maryland, United States; 4Florida International University, Miami, Florida, United States; 5Weill Cornell Medicine, New York, New York, United States;
Introduction: As Obesity pandemic climbs, bariatric surgery numbers pursue, specially Laparoscopic Seeve Gastrectomy(LSG). It lessens the greater curvature of the Stomach resulting in a sleeve-shaped chamber. Although mechanically simple and effective for weight loss(WL), LSG demands enlarged costs due to multiple serious events and increased prevalence of worsened or reapearance of GERD, which could lead to esophageal adenocarcinoma. Limited to those with a Body Mass Index(BMI )of 35 with comorbidities or above 40. Endoscopic Sleeve Gastroplasty(ESG) is a minimally invasive endoscopic surrogate to LSG that offers the benefits of an effective procedure to those who don't qualify for or wish to persue surgery. It can be performed at an earlier stage of the disease, at a BMI of 30.Acting earlier inhibits premature deaths due to complications of obesity and lowers costs associated with treatments.Lamentably,average Total Body Weight Loss(TBWL) is still around 20%, abaft the expected after LSG.
However,WL is a recognized outcome of glucagon-like peptide-1 receptor agonists(GLP-1).Semaglutide(SG) belongs to this class with a half-life of 1 week. Therefore, in order to bring about the WL potential of the LSG we proposed the association of SG therapy after ESG.
Aims: To acess the effects of BMI,occurance of side effects;possible alterations in amylase and lypase. Results regarding %TBWL, %Excess Weight Loss(EWL) ,changes in Glycated Hemoglobin(Hb1Ac) in Body Fat Mass(BFM) on those using SG as an adjunct to ESG.
Methods: Double blinded clinical prospective study involving those who underwent ESG with same sutturing patterns, dieting and exercising prescriptions, followed by same team. 2 groups defined: SG and Sham(SH), provided with similar pens, randomly, after 5th month ESG completion. Weekly adjustments based on one's symptoms. Initial dosage set to 0.25mg and maximum dose set to 1.5 mg. Monthly consults for weight and bioimpedanciometry avaliation. Blood panels in a 3-month basis.Irregular users excluded. P set to .005. Student-t , Mann-Whitney and K-S tests for data analysis.
Results:SG(27), mean age 34, women 20;SH(28), mean age 36, women 21. %TBWL was respectively 26.7+-1.8 and 19.6+-1.3 for the SG nad SH groups.(p<0.0001)%EWL was 86.3+-11.8 and 60.4+-9.4(p<0.001). Delta %BFM was 12.7+-2.1(SG) and 9+-1.8(SH)(p<0.001).Delta H1bAc was .95+-.35(SG) and .61+-.77(SH) p=0.0394. Amylase and lypase indiferent.All SG doses were generally well tolerated, with no new safety concerns. Most common adverse events were dose-related GI symptoms(nausea).
Conclusions: Associating SG to the ESG procedure not only potentializes WL but the outcomes reach the average WL presented in the LSG. Great decrease in BFM preventing sarcopenic obesity. Adhesion to treatment was significant as well as changes in Hb1Ac.