Longer Term Outcomes for the “Accordion” Sleeve

While gastric sleeve procedures became the most common form of bariatric surgery in the U.S., a new and less invasive approach has been coming along. An “Accordion” sleeve procedure shrinks a person’s stomach through an advanced suturing process – no surgical incision required. Later this week, researchers will present the first data on longer term outcomes. Reem Sharaiha will reveal data on five-year outcomes in the Presidential Plenary Session at Digestive Disease Week in San Diego on Saturday.

Less Invasive, Less Effective

The basics of this procedure are reasonably clear. First and foremost, endoscopic sleeve gastroplasty is not a surgical procedure. So it’s less invasive than sleeve gastrectomy. Instead of cutting away part of the stomach, this procedure shrinks it by stitching it up from the inside, using an endoscope. The nickname comes from the way an accordion shrinks by folding up on itself. However, the comparison to a sleeve gastrectomy might be misleading. No stomach tissue is removed with this new procedure.

The tradeoff is simple. With a safer, less invasive procedure, you get less efficacy. In a recent comparative study, patients lost about 17 percent of their weight with the nonsurgical accordion sleeve. In comparison, matched control patients lost significantly more weight with surgery – 24 percent. But the surgical sleeve patients had more than three times as many adverse events.

So the tradeoff seems pretty straightforward. The missing piece of the puzzle has been long-term outcomes.

Five-Year Outcomes

The data that Sharaiha will present on Saturday suggests that the outcomes hold up pretty well. After five years, she found that patients regained about 14 percent of the weight they initially lost. Thus, in this group of patients after five years, their net weight loss was still 15 percent of their starting weight.

Though this is less than a patient might expect from bariatric surgery, Sharaiha says this procedure has advantages for some patients:

It’s a simple, one-day outpatient procedure. And it leaves no scar, which seems to be the major appeal to patients.

Evolving Options

With good reasons, many thoughtful observers remain skeptical. It might be a good option for patients with milder obesity, says Mitchell Roslin. He’s the chief of obesity surgery at Lenox Hill Hospital in New York City. But for patients with more severe obesity he says flatly that he expects it won’t be a durably effective option.

The truth is that a clearer picture will only come with time. This accordion sleeve procedure is a new option that’s not widely available. Doctor Sharaiha and her colleagues have only been doing it for six years now.

Nonetheless, having more options is a good thing. And for the right patients, this option appears to be promising.

Click here for the press release from DDW. For further perspective, click here and here.

Accordion on the Street, photograph © Lydia Brooks / flickr

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May 13, 2019