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Original research
Effect of endoscopic sleeve gastroplasty on gastric emptying, motility and hormones: a comparative prospective study
  1. Eric J Vargas1,
  2. Monika Rizk1,
  3. Jacky Gomez-Villa1,
  4. Phillip K Edwards2,
  5. Veeravich Jaruvongvanich1,
  6. Andrew C Storm1,
  7. Andres Acosta1,
  8. David Lake2,
  9. Jeff Fidler3,
  10. Adil E Bharucha1,
  11. Michael Camilleri1,
  12. Barham K Abu Dayyeh1
  1. 1Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  2. 2Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Barham K Abu Dayyeh, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R), Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA; abudayyeh.barham{at}


Objective Endoscopic sleeve gastroplasty (ESG) has gained global adoption but our understanding of its mechanism(s) of action and durability of efficacy is limited. We sought to determine changes in gastric emptying (GE), gastric motility (GM), hormones and eating behaviours after ESG.

Design A priori-designed single-centre substudy of a large US randomised clinical trial, adults with obesity were randomised to ESG or lifestyle interventions (LS) alone. We measured GE, hormones and weight loss and assessed eating behaviours. In a subset of ESG patients, we assessed GM. The primary outcome was the change in T1/2 (min) at 3 months, and secondary outcomes were changes in weight, GE, GM, hormones and eating behaviours. We used t-test analyses and regression to determine the association between GE and weight loss.

Results 36 (ESG=18; LS=18) participated in this substudy. Baseline characteristics were similar between the two groups. At 3 months, T1/2 was delayed in the ESG group (n=17) compared with the LS group (n=17) (152.3±47.3 vs 89.1±27.9; p<0.001). At 12 months, T1/2 remained delayed in the ESG group (n=16) vs control group (n=14) (137±37.4 vs 90.1±23.4; p<0.001). Greater delays in GE at 3 months were associated with greater weight loss. GM was preserved and fasting ghrelin, glucagon-like peptide 1 and polypeptide YY significantly increased 18 months after ESG.

Conclusion ESG promotes weight loss through several key mechanistic pathways involving GE and hormones while preserving GM. These findings further support clinical adoption of this technique for the management of obesity.

Trial registration number NCT03406975.

  • obesity
  • gastric emptying

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Twitter @EricJVargasMD, @dr_aac

  • Contributors EJV: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript. VJ: acquisition of data, analysis and interpretation of data. ACS, AA, JF, MR, JG-V, PKE and DL: interpretation of data and critical revision of the manuscript. MC and AEB: study concept and design, interpretation of data, drafting and critical revision of the manuscript. BKAD: guarantor, study concept and design, drafting and critical revision of the manuscript, interpretation of data, study supervision. All authors reviewed and approved the final submitted manuscript.

  • Funding MC: grant R01-DK67071 from National Institutes of Health (NIH) for studies in obesity. AEB: grant R01-DK78924 from NIH. The study was made possible by CTSA grant number UL1-TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of NIH.

  • Competing interests ACS: research grant support from Apollo Endosurgery, Boston Scientific, Endogenex, Endo-TAGSS and Enterasense. Consultant for Apollo Endosurgery, ERBE, GI Dynamics, Intuitive and Olympus; AA: stockholder in Gila Therapeutics, Phenomix Sciences; consultant fees from Rhythm Pharmaceuticals, General Mills; BKAD: consulting fee from Endogenex, Endo-TAGSS, Metamodix and BFKW; consulting fee and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics and Boston Scientific; speaker honorarium from Olympus and Johnson and Johnson; speaker honorarium and grant/research support from Medtronic and EndoGastric Solutions; and research support/grant from Apollo Endosurgery and Spatz Medical; MC: advisor to Phenomics Sciences, holder of stock options.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.