Efficacy And Safety Of Endoscopic Gastric Mucosal Ablation For Treatment Of Obesity

Background and ObjectiveObesity is one of the most common diseases in the world.It is a risk factor for many diseases,such as hypertension and type 2 diabetes,and poses a great threat to human health.Patients with moderate to severe obesity can achieve a lasting weight loss and a relief of obesity-related complications through surgery.Laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are two major surgical procedures for weight loss,but they can cause a variety of postoperative complications.With the idea of safer,more effective and minimally invasive treatment,endoscopic technology has a broad application prospect.Intragastric balloon(IGB),Endoscopic sleeve gastroplasty(ESG),aspiration therapy and other endoscopic minimally invasive treatments have gradually been developed,but the clinical application of these endoscopic bariatric therapies(EBTs)is limited due to poor patient tolerance and high cost.Studies have shown that severe esophageal stenosis occurs after extensive mucosal dissection of early esophageal cancer under endoscopy.Therefore,Liu Bingrong et al.proposed the conjecture that endoscopic gastric mucosal ablation(EGMA)can lead to gastric cavity constriction and gastric volume reduction,which can reduce calorie restriction to achieve weight loss,and that has been verified in animal experiments.The purpose of this study was to evaluate the efficacy and safety of EGMA in the clinical treatment of obesity.MethodsThe general data and clinical characteristics of obese patients who underwent EGMA from July 2015 to August 2020 were collected and followed up after surgery.Surgical methods:endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)were used to remove 80%of the mucosa in the greater curvature of the stomach,fundus and the anterior and posterior wall of the gastric body,and some mucosal islands were reserved in the middle.Postoperative fasting,acid suppression,anti-infection,mucosal protection and other treatments were given.The patients were followed up at 1,3,6,12 and 24 months after surgery.The data of operative duration,hospital stay,complications,preoperative and postoperative body weight,gastric volume,and relevant biochemical indexes were collected.SPSS 21.0 software was used for statistical analysis.All measurement data were expressed in the form of mean ± standard deviation(M±SD),and enumeration data were expressed in frequency and percentage(%).One-way ANOVA was used to compare the changes of weight related parameters and metabolic indicators in different periods.P<0.05 indicates that the difference is statistically significant.ResultsFrom July 2015 to August 2020,a total of 16 cases of obese patients underwent endoscopic gastric volume reduction,including 12 females and 4 males,with an average age of(34.8±13.0)years.All operations were successfully performed,with an average operation time of(9.4±3.2)hours and an average postoperative hospital stay of(8.7±2.3)days.The average follow-up time of the 16 patients was(26.7±18.2)months.The average body weight loss of 1,3,6,12 and 24 months after surgery was(13.1±3.9)kg,(20.2±6.3)kg,(23.7±10.3)kg,(23.2±10.8)kg,(24.5±11.7)kg,respectively.Percentage of excess weight loss(EWL%)were(42.3±17.8)%,(61.7±21.9)%,(74.3±32.2)%,(73.7±30.6)%,(70.1±20.1)%,respectively.The remeasurement of gastric volume was completed in 9 patients,and the mean gastric volume decreased from(1409±657)mL preoperatively to(419±164)mL(P<0.05).There was no significant weight rebound in all patients during the follow-up period,and the metabolic indicators corresponding to obesity-related complications such as diabetes mellitus,hypertension,hyperlipidemia and hyperuricemia decreased significantly after surgery(P<0.05).There were 4 cases of gastrointestinal bleeding,of which 2 cases received emergency endoscopic hemostasis.One patient developed perforation and was cured after conservative treatment.One patient developed gastric obstruction one month after the operation,and resumed eating after endoscopic dilation and endoscopic stent placement.There were no deaths.There were none adverse events such as anemia,hypoproteinemia,liver and kidney dysfunction were found in all patients during the follow-up period.ConclusionEndoscopic gastric volume reduction for the treatment of obesity is safe,effective,less traumatic,and has a good clinical application prospect.