Clinical Scorecard: Results of Endoscopic Sleeve Gastroplasty in Older Adults

At a Glance

Key Highlights

• ESG is a safe and effective minimally invasive procedure for weight loss in older adults with obesity.
• Median excess weight loss (EWL%) at 6 and 24 months was approximately 39% and 41%, respectively; median total body weight loss (TBWL%) was about 15%.
• No peri-procedural or post-procedural adverse events occurred; mild transient abdominal pain was managed conservatively.

Guideline-Based Recommendations

Diagnosis

• Evaluate obesity in older adults with BMI calculation and assessment of obesity-related comorbidities such as hypertension, diabetes, and obstructive sleep apnea.

Management

• Consider ESG as a minimally invasive alternative for older patients excluded from bariatric surgery or those refusing surgery.
• Perform ESG under general anesthesia using Apollo OverStitch® system with appropriate endoscopes.
• Implement multidisciplinary team evaluation including endoscopists, surgeons, endocrinologists, nutritionists, and psychologists before procedure.

Monitoring & Follow-up

• Schedule follow-up visits at 1, 3, 6, 12, 18, and 24 months post-ESG to monitor BMI, EWL%, TBWL%, and BAROS scores.
• Assess improvement or resolution of obesity-related comorbidities at each follow-up.

Risks

• Minimal risk of adverse events; mild crampy abdominal pain may occur within 12–24 hours post-procedure and is manageable with antispasmodics.
• No reported vomiting, gastroesophageal reflux symptoms, or dysphagia in studied cohort.

Patient & Prescribing Data

Older adults (≥65 years) with obesity, including those at high surgical risk or refusing bariatric surgery.

ESG provides comparable weight loss outcomes to younger patients undergoing the same procedure, with a favorable safety profile and short hospital stay (24–48 hours).

Clinical Best Practices

• Use a multidisciplinary team approach for patient selection and pre-procedure evaluation.
• Obtain informed consent and adhere to ethical standards including Declaration of Helsinki.
• Perform ESG under general anesthesia with appropriate endoscopic equipment.
• Provide close post-procedure monitoring and multidisciplinary follow-up to assess weight loss and comorbidity status.
• Manage mild post-procedural abdominal pain with antispasmodics and monitor for any adverse symptoms.

References

• Obesity prevalence and aging
• Endoscopic Sleeve Gastroplasty efficacy and safety
• Bariatric surgery in elderly patients
• Bariatric Analysis and Reporting Outcome System (BAROS)