The prospect of losing weight for many can seem insurmountable. When regular weight-loss plans, diets and exercise strategies don't work out — and when comorbidities, such as high blood pressure, diabetes, hyperlipidemia (elevated fats in the blood) and metabolic syndrome are involved — then more complex medical approaches are called upon. Sometimes that may mean gastric bypass, but not everyone is a candidate for that level of surgical intervention.  

But there is a middle ground called endoscopic sleeve gastroplasty. This treatment is endoscopic because it can be done in an outpatient setting via an endoscope inserted in the throat without a surgical incision.  

The procedure entails suturing a length of the stomach to narrow it and expose less of the organ to food. Unlike some surgeries, this option can be reversed by removing the sutures or retightened with time to maintain durability.  

While endoscopic sleeve gastroplasty has been approved by the Food and Drug Administration, it has not been studied in a large-scale, randomized way as part of a combination therapy for obesity.  

That is until now. 

Mayo Clinic researchers, along with colleagues at several major medical centers, enrolled 209 volunteers into randomized control and treatment groups. These were people who had no success at conventional weight loss and were mildly or moderately obese. Initially, 85 people received the gastroplasty and agreed to dietary and other lifestyle changes. This group committed to sticking to these changes for life.  

The 124 members of the control group did not have the procedure but made the same lifestyle changes.  

After a year, some significant differences were clear: 

• Participants in the treatment group had lost 13.6% total body weight loss, compared to 0.8% in the control group.  
• Of those in the treatment group, 80% showed improvement in one or more comorbidities. 
• After two years, 68% of the treatment group had maintained 25% or more of their weight loss.  
• Half of those in the control group saw one or more of their comorbidities worsen over the same period. 

Most participants in each group were women, and the median age was middle to late 40s.  

After one year, participants in the control group crossed over to the treatment group if they met requirements. Then they achieved similar weight-loss outcomes.  

Roughly 12% of the overall group could not continue with the study due to the onset of the COVID-19 pandemic, which limited their access to in-person visits to research centers. Enough were able to continue to provide reliable data.  

The researchers say their findings, which are published in The Lancet, show endoscopic sleeve gastroplasty is a safe and effective treatment for class 1 and class 2 obesity when used in combination with individually prescribed diet and exercise programs. They emphasize that one type of therapy will not work for everyone, and treatment regimens need to be personalized.  

The research was funded by Apollo Endosurgery Inc. and Mayo Clinic. A full list of authors and affiliations is in the research article.  

— Bob Nellis 

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