Review about Psychological Barriers to Lifestyle Modification, Changes in Diet Habits, and Health-Related Quality of Life in Bariatric Endoscopy.

Obesity is an expanding disease responsible for significant deterioration in the Health-Related Quality of Life (HRQL) of those who suffer from it. Bariatric Endoscopy (BE) therapies have proven to be an effective treatment for this pathology. A multidisciplinary approach is essential for the successful therapeutic management of BE. This article addresses the multidisciplinary treatment of BE by considering the possible variables that can influence treatment. In particular, the variables that can facilitate or hinder changes in patients' habits are discussed. These include the neuropsychological, emotional, and social implications that may influence the formation of healthy habits necessary for improvement in a patient's quality of life; the individual and environmental psychological factors that influence the monitoring of nutritional and physical activity indications; and different psychological disorders such as depression, anxiety, or disorders related to eating. The main objective of BE treatment, except in certain special biological situations, must be to establish a long-term sustainable change in habits such that patients, once they reach a healthy weight, do not revert to the lifestyle that caused their obesity, as well as identifying and addressing major problems that may exist prior to, or arise during, treatment.

Primary obesity surgery endoluminal (POSE-2) procedure for treatment of obesity in clinical practice.

BACKGROUND: The POSE-2 procedure shortens and narrows the stomach using multiple full-thickness plications in the gastric body. We studied the efficacy and safety of POSE-2 for obesity at 1 year in a real-world setting. METHODS: We reviewed the records of 75 patients who underwent POSE-2 at our unit. The primary outcome was percentage total body weight loss (%TBWL) at 1 year. Secondary outcomes were safety and durability. We used linear mixed model analysis. RESULTS: 46 patients completed 1 year. Mean age and body mass index (BMI) were 49.3 years (standard deviation [SD] 10.2) and 38.2 kg/m2 (SD 6.6), respectively. Technical success rate was 98.7 % (n = 74). Mean TBWL, %TBWL, and BMI decline at 1 year were 20 kg (SD 12.7), 17.8 % (SD 9.5), 7 kg/m2 (SD 4.3). Adverse events occurred in four patients. The median length of stay was 1 day. Endoscopy at 1 year in 15 patients showed intact sutures and a reduction in gastric length compared with baseline (26.9 cm [SD 5.3] vs. 35.7 cm [SD 3.5]; P < 0.001). CONCLUSION: POSE-2 induced significant weight loss at 1 year. It appears to be safe, durable, and required only a short hospital stay.

Re-suturing after primary endoscopic sleeve gastroplasty (ESG) for obesity.

INTRODUCTION: Although primary endoscopic sleeve gastroplasty (P-ESG) is effective, some patients may require revision procedures to augment weight loss. We hypothesized that a non-surgical approach using redo ESG (R-ESG) might be a viable option in such patients. We aimed to assess the safety and efficacy of R-ESG following P-ESG to treat obesity. METHODS: We reviewed the outcome of patients who underwent R-ESG at our unit. We classified them as weight loss failure (WF)-< 10% total body weight (TBWL) at 6-months; weight regain (WR)-lost ≥ 10% TBWL and regained 50% of the maximum weight loss at or after 1-year; weight plateau (WP)-lost ≥ 10% TBWL but could not lose further over 3-months. We analyzed the feasibility, safety, and evaluated the efficacy of R-ESG in each group. RESULTS: Of the 482 patients who underwent P-ESG, 35 (7%) required R- ESG (WF-12, WR-12, WP-11). The mean age, weight, BMI (38.2 kg/m2), and the number of sutures used during P-ESG were similar between the groups. The nadir %TBWL was lowest in WF group compared to WR and WP (6.5% vs. 20% vs. 22.4%, p = 0.001). The mean BMI at R-ESG was 33.6 kg/m2. The time to R-ESG was longer in the WR group compared to WF and WP (22.3 vs. 13.4 vs. 13.7 months, p = 0.03). We placed a median of 3 (range 2-6) sutures. R-ESG was technically successful, and no serious complications occurred. All except two patients were discharged on the same day. The overall %TBWL achieved by R-ESG was significantly higher in WP (26%) as compared to WF (11.2%) and WR (12%), respectively (p = 0.001). CONCLUSION: The need for R-ESG after P-ESG is low. R-ESG is safe and induced weight loss in all patients. The maximum benefit was observed in WP.