Abstract Introduction: Obesity remains a pressing global health issue, with no universally effective solution. Both endoscopic sleeve gastroplasty (ESG) and intragastric balloon (IGB) are established as safe and effective weight-loss interventions. With ESG demonstrating considerable success, it is crucial to evaluate its efficacy against IGB therapy.
Methods: This retrospective cohort study analyzed data from patients who underwent either ESG or IGB. Weight was monitored at one week, one month, and three months post-procedure, and the percentage of total body weight loss (%TBWL) was calculated. Severe adverse events requiring hospitalization or procedure reversal were also documented. The study aimed to determine which of these procedures is more effective in promoting short-term weight loss.
Results: The study included 20 patients in the ESG group and 31 patients in the IGB group. At one week post-procedure, ESG patients showed a higher mean %TBWL (4.87±1.88 vs 3.76±1.95 for IGB). However, at one month, IGB patients exhibited a greater %TBWL (8.00±3.60 vs 7.25±3.29 for ESG). By the three-month mark, both groups demonstrated comparable weight loss outcomes (%TBWL ESG = 10.857±3.83 vs %TBWL IGB = 10.852±5.78).
Conclusion: Both ESG and IGB result in significant weight loss within a short-term period. Although the weight loss outcomes were similar between the two procedures, the IGB group experienced a significantly higher rate of adverse events compared to the ESG group.
Introduction: Obesity is a major public health crisis worldwide, with no fully satisfactory treatment options available [1]. According to the WHO, obesity is defined by the excessive accumulation of fat that poses serious health risks [2]. While bariatric surgery remains the standard approach for managing severe obesity [3], only 1-2% of eligible patients undergo surgery each year [3,4]. In the U.S., obesity ranks as the second leading cause of preventable death, following smoking [4]. Obesity is typically classified using body mass index (BMI = weight (kg)/height (m²)), which correlates a person’s body weight with their height [5].
Intragastric balloon (IGB) is a space-occupying device proven to induce weight loss by reducing stomach volume and slowing gastric emptying [6-8]. Meta-analyses report that patients receiving IGB therapy achieve around 13.16% TBWL at six months [9], with one study citing a slightly lower 9.7% TBWL [9-11].
Endoscopic sleeve gastroplasty (ESG) is a less invasive, endoscopic procedure that reduces stomach volume by using sutures to reconfigure the stomach into a smaller tubular shape [9]. Both ESG and IGB are effective and safe for weight reduction, with the choice of procedure depending on patient preference following informed consent. This study hypothesizes that ESG would outperform IGB in promoting weight loss with fewer complications.
Methods: Patient Population: This retrospective cohort study examined 54 patients who underwent either IGB or ESG between June 2022 and June 2023 at a private hospital in Jakarta, Indonesia. The study excluded patients who had balloon removal or a normal BMI. Ultimately, 31 IGB patients and 22 ESG patients were included, with 5 IGB patients requiring procedure reversal due to balloon intolerance.
Before selecting a procedure, patients were counseled on various weight loss interventions, including bariatric surgery. Both ESG and IGB procedures were self-funded, with IGB costing approximately US$ 3,650 and ESG around US$ 10,150.
Pre- and Post-Procedural Care: All procedures were carried out by experienced endoscopic surgeons. Preoperative medications for the IGB group included omeprazole for 10 days. Postoperatively, IGB patients continued taking omeprazole while the balloon remained in place. Patients adhered to a liquid diet for two weeks post-procedure before transitioning to soft or solid foods based on individual tolerance.
IGB Insertion: Candidates for IGB had a BMI > 27 kg/m² and had previously failed to lose weight through other means. The Orbera balloon was used, filled with 500-550 cc of saline and methylene blue for leak detection, and inserted under general anesthesia.
ESG Procedure: ESG was indicated for patients with a BMI > 30 kg/m² who had been unsuccessful with other weight loss methods. Contraindications included a history of gastric cancer, active Helicobacter pylori infection, and organ failure. ESG was performed under general anesthesia in the operating room.
Outcomes: Data on age, sex, initial weight, height, and BMI were collected. Patients were contacted by a clinical nurse at one week, one month, and three months post-procedure to assess TBWL and %TBWL. Adverse events requiring hospitalization were recorded, though expected side effects like nausea, vomiting, and abdominal discomfort were excluded from this data.
