Endoscopic sleeve gastroplasty MERITs consideration for mild-to-moderate obesity

medwireNews: People with mild-to-moderate obesity who undergo minimally invasive endoscopic sleeve gastroplasty (ESG) in addition to lifestyle intervention achieve greater weight loss and metabolic improvements than those undergoing lifestyle modification alone, show the MERIT trial results.

As reported in The Lancetthe study included 187 people with class 1–2 obesity (BMI 30 to <40 kg/m2) and an inadequate response to previous nonsurgical weight-loss interventions who were randomly assigned to receive 1 year of moderate-intensity lifestyle modifications either with (n=77) or without (n=110) ESG. The lifestyle intervention involved a low-calorie diet plan and individually-tailored physical activity counseling.

At the 1-year follow-up, participants in the ESG group achieved an average excess weight loss of 49.2%, with excess weight defined as that over the ideal bodyweight for a BMI of 25 kg/m². This was significantly higher than that achieved in the control group, at 3.2%.

Similarly, people who underwent ESG had significantly greater average total body weight loss compared with those in the control arm, at 13.6% versus 0.8%.

Participants in the ESG arm who had type 2 diabetes at baseline (n=18) were significantly more likely than their counterparts in the control group (n=36) to experience clinical improvements in their diabetes during 1 year of follow-up, with rates of 92% versus 15%. A similar pattern of results was seen for improvements in hypertension and the metabolic syndrome.

Barham Abu Dayyeh (Mayo Clinic, Rochester, Minnesota, USA) and co-authors say that after 1 year in the study, people in the ESG group could undergo retightening if required and all participants in this arm were followed up for an additional year. Of the 60 individuals who achieved at least 25% excess weight loss at 1 year, 68% maintained this at the 2-year follow-up.

The investigators report that ESG had a favorable safety profile, with 2% of participants given ESG experiencing a procedure- or device-related adverse event of grade 3 or worse. These events included abdominal abscess, upper gastrointestinal bleed, and malnutrition, and were managed without the requirement for intensive care or surgery; none of the events were fatal.

Taken together, the MERIT trial results suggest that ESG “provides an option for a non-surgical, non-pharmacological solution for weight loss and management of comorbid conditions, especially for individuals who are not willing to consider or do not qualify for surgery as a treatment option,” write Abu Dayyeh et al.

They also note that “ESG might also allow for combination treatment with pharmacological options, depending upon personal goals of individuals.”

Writing in an accompanying comment, Vitor Ottoboni Brunaldi (University of São Paulo, Brazil) and Christine Stier (University Hospital Würzburg, Germany) say that “these results are impressive,” but 5- and 10-year data are “essential” given the “chronic, relapsing, and progressive” nature of obesity.

“Additionally, there is a need for well designed randomised controlled trials comparing ESG with surgical bariatric techniques such as sleeve gastrectomy to better define the spectrum of indications and patient selection criteria for endoscopic suturing procedures,” they add.

The commentators conclude: “While we wait for such data, the MERIT trial provides clear evidence that ESG is safe and systematically effective in treating mild-to-moderate obesity in the short term and is a welcome addition to treatment options available for patients.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet 2022; doi:10.1016/S0140-6736(22)01280-6
Lancet 2022; doi:10.1016/S0140-6736(22)01380-0

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