Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss.

BACKGROUND AND AIMS: Endoscopic sleeve gastroplasty (ESG) has been shown to be effective for inducing weight loss. The efficacy of liraglutide, a glucagon-like peptide-1 agonist, to augment weight loss after ESG is unknown. This study aims to evaluate the efficacy of ESG and liraglutide (ESG-L) compared with ESG alone. METHODS: This was a retrospective study of prospectively collected data from patients undergoing ESG at 3 outpatient clinics in Brazil between November 2017 and July 2018. Liraglutide was offered to all patients 5 months after ESG. Patients who opted to take liraglutide (ESG-L) were matched 1:1 to patients who declined it (ESG). The primary outcome was percent total body weight loss (%TBWL), and percent excess weight loss (%EWL) 7 months after initiation of liraglutide (12 months after ESG). The secondary outcome was change in percent body fat 12 months after ESG. ESG technique and postprocedure follow-up were identical at all 3 sites. RESULTS: Propensity score matching yielded 26 matched pairs. Adjusted comparisons between the 2 groups showed that patients who opted to take liraglutide had a superior mean %TBWL 7 months after initiation of liraglutide (ESG-L) compared with those who declined it (ESG) (24.72% ± 2.12% vs 20.51% ± 1.68%, respectively; P < .001). ESG-L had a statistically greater reduction in percent body fat compared with ESG (7.85% ± 1.26% vs 10.54% ± 1.88%, respectively; P < .001) at 12 months. CONCLUSIONS: Addition of liraglutide at 5 months results in superior weight loss and improved efficacy as demonstrated by decreased body fat 12 months after ESG. Further studies are imperative to determine optimal dose, timing, and duration of liraglutide.

The Effect of the Intra-gastric Balloon on Gastric Emptying and the DeMeester Score.

BACKGROUND AND AIMS: The mechanism of weight loss with the intra-gastric balloon (IGB) is thought to be a decrease in gastric emptying (GE); however the evidence is conflicting. Nausea, abdominal pain, and gastroesophageal reflux disease (GERD) can cause intolerance resulting in early removal. This is demoralizing for the patient and costly for the healthcare system. The ability to predict which patients will have superior weight loss and tolerance is invaluable. We sought to investigate if the IGB induced weight loss by reducing GE and the effect of the IGB on the DeMeester score. METHODS: We retrospectively reviewed prospectively collected data for patients undergoing IGB placement at a single hospital. Manometry and pH studies were performed before and with the IGB in place. Weight was measured at baseline, at removal, and 6 months later. Adverse events leading to early removal were recorded. RESULTS: Twenty-four patients were evaluated. There was a statistically significant decrease in GE for solids with the IGB (117.92 ± 150.23 vs 281.48 ± 206.49 min; p = 0.0048), but not for liquids (54.44 ± 17.97 vs 56.08 ± 43.96 min; p = 0.7228). The lower esophageal sphincter (LES) pressure did not change significantly with placement of the IGB (17.76 ± 7.39 vs 14.74 ± 7.24 mmHg; p = 0.09). On multivariate analysis, increase in DeMeester score was associated with total body weight loss (p = 0.0125) and change in GE (p = 0.038) independently. CONCLUSION: The IGB delays GE for solids, but not for liquids, and increases the DeMeester score by a mechanism other than a loss of LES pressure.

What are the long-term results of endoscopic pancreatic sphincterotomy for pancreatitis?

Endoscopic pancreatic sphincterotomy (EPS) has been touted as effective therapy for several disorders including chronic pancreatitis and unexplained abdominal pain associated with pancreatic sphincter dysfunction (pSOD). Although short-term data are encouraging, there are no reports on how these patients fare beyond the first few months after EPS. The data on all patients who had EPS performed at the Johns Hopkins Hospital over a 4 year period between August 1992 and November 1996 were reviewed. Patients were then contacted by a physician other than the original endoscopist and asked to rate their pain using the linear pain scale score (0-10 where 10 is the worst possible pain). Patients were asked to score their pain before EPS and also at follow-up. Clinical improvement was defined as a >50 percent reduction in the pain score. The data on 55 patients were available for review. There were 17 men and 38 women age (yrs) ñSD: 43.6 ñ 16.7. Indications for EPS included 1) chronic pancreatitis (n=40); 2) unexplained abdominal pain with pSOD (n=15). EPS was associated with pancreatitis in 5 patients (9 percent), bleeding in 2 (3.6 percent) and early stent occlusion in 5 (9 percent). 7 patients had surgical sphincteroplasty after EPS. No patient died from EPS. After a median follow-up of 16 months (longest, 52 months) 60 percent of all patients improved, with an overall improvement in pain scores (mean ñ SD) from 8.8 ñ 1.8 pre-EPS to 3.6 ñ 3.4 post-EPS (p<0.0001). The response rate was even more impressive in the pSOD group with 73 percent of the patients reporting improvement and a reduction in pain scores from 9.0 ñ 1.6 to 2.9 ñ 3.3 after sphincter ablation (p<0.001). In a subgroup of patients with pancreatic disease and pancreatic sphincter dysfunction, EPS results in sustained significant clinical improvement.(AU)