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Obesity, the first endoscopic vertical gastroplasty operations at Casa Sollievo

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Obesity, the first endoscopic vertical gastroplasty operations at Casa Sollievo

A 54-year-old hypertensive man with dysmetabolic syndrome, a 38-year-old woman undergoing several spinal stabilization surgeries, and a 33-year-old man with severe steatohepatitis were the first 3 obese patients undergoing vertical endoscopic gastroplasty (Gve , also known as endoscopic sleeve gastroplasty, Esg) performed in the Gastroenterology and Digestive Endoscopy Unit of the Irccs Casa Sollievo della Soflievo in San Giovanni Rotondo.

It is an innovative, minimally invasive procedure designed to make properly selected obese patients lose weight who have failed previous medical and dietary treatments. Obesity, recognized by the WHO as a disease since 1936, is a risk factor for other diseases such as diabetes, arterial hypertension, cardiovascular disease, sleep apnea, dysmetabolic liver disease, joint diseases and even some types of cancer (breast, colon, prostate, etc.), so losing weight is of paramount importance.

According to the data published by the International Obesity Task Force, in Italy the percentage of overweight subjects is about 35%. The trend is worrying if we consider that the number of obese Italians from 1994 to today has grown by 25%. There are currently around 16.5 million overweight individuals and around 5.5 million obese patients. In view of the extent of the problem in social, health and economic terms, the European Association for the Study of Diabetes (Easd) recognizes the importance of preventing and treating obesity which is to be considered “The most important public health problem in the world“.

Despite the urgency of the problem, however, Italian patients who undergo bariatric surgery every year are less than 1% of the total. Endoscopic vertical gastroplasty (Gve) is a safe and effective minimally invasive therapeutic option that complements the possibilities of bariatric surgery and is sometimes an alternative. The procedure uses a gastroscope and an endoscopic stapler capable of plicating the stomach walls with full thickness sutures, reducing their volume in a similar way to the surgical procedure but without irreversible resections and without significant complications.

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ā€œPatients with BMI (body mass index) between 30 and 40, who do not want or cannot, due to age and comorbidities, undergo surgical procedures, or patients with BMI greater than 40, as a bridge to surgery are eligible for the endoscopic procedure. “, explains Francesco Perri, director of the Gastroenterology and Digestive Endoscopy Unit of the Irccs Casa Sollievo della Soflievo. ā€œFor the evaluation of patients, who are also sent to us by colleagues from other hospitals, preliminary clinical and instrumental examinations are necessary. However, suitability for endoscopic surgery remains a prerogative of the multidisciplinary team “.

“The procedure is performed under general anesthesia, thanks to the support of the Anesthesia and Intensive Care Unit 1, lasts about 30 minutes and allows a quick return to daily activities after only 2 nights in hospital – adds Rossella Cubisino, endoscopist of Casa Sollievo, who performed the first vertical endoscopic gastroplasty under the supervision of Professor Ivo BoÅ”koski of the Gemelli Polyclinic in Rome, one of the leading experts in bariatric endoscopy on the international scene. ā€œAs with all bariatric operations, the multidisciplinary team made up of bariatric surgeon, endocrinologist, endoscopist, clinical nutritionist, psychiatrist and psychologist plays a fundamental role. Before and after the surgery, it must be emphasized, the willingness of the patient to undertake a healthy and balanced lifestyle, to carry out physical activity and to carefully follow all medical indications is fundamental ā€.

ā€œEndoscopic vertical gastroplasty – explained Michele Giuliani, general manager of the San Giovanni Rotondo Hospital – represents an important innovation for the treatment of obesity, a pathology for which both the Dietology and Clinical Nutrition Unit and a specific clinic in the Endocrinology Unit that makes use of a multidisciplinary team have already been active in our Institute expert. Furthermore, for patients not eligible for endoscopic vertical gastroplasty, it has already been possible to perform bariatric surgery at the Abdominal Surgery Unit for many years. In the Puglia Region, however, bariatric operations are performed in a limited number and an estimated average annual request of about 1000 procedures cannot be met. Most of these patients – concluded Giuliani – it is therefore forced to turn to other extra-regional centers. With the launch of this new method, the IRCCS Casa Sollievo della Soflievo is a candidate to become a reference center for the treatment of obesity “.

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