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Bariatric endoscopic antral myotomy: a pilot study assessing technical feasibility, physiologic changes, and
Christopher C Thompson1, Pichamol Jirapinyo1
1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Gastrointestinal Endoscopy
|May 10, 2024
Summary
Bariatric endoscopic antral myotomy (BEAM) is a feasible endoscopic procedure that delays gastric emptying, leading to significant weight loss. This method shows promise for obesity treatment without causing gastroparesis symptoms.
Area of Science:
- Bariatric Endoscopy
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastric balloons and endoscopic sleeve gastroplasty leverage delayed gastric emptying for weight loss.
- Pylorus-sparing antral myotomy is hypothesized to inhibit the antral pump, inducing gastric retention and weight loss.
Purpose of the Study:
- To assess the feasibility, safety, and efficacy of bariatric endoscopic antral myotomy (BEAM).
- To evaluate changes in gastric emptying rate and gastroparesis symptoms post-BEAM.
Main Methods:
- Pilot study involving submucosal tunneling for BEAM.
- Primary outcomes: feasibility, safety, and efficacy at 6 and 12 months.
- Secondary outcomes: gastric emptying rate and Gastroparesis Cardinal Symptom Index (GCSI) score.
Main Results:
- Successful BEAM in six subjects; one required needle decompression, one had a pulmonary embolism.
- Significant total weight loss achieved: 9.1% ± 8.9% at 6 months and 12.2% ± 7.1% at 12 months (P < .0005).
- Gastric emptying delayed by 36.6% in patients with ≥10% weight loss; GCSI score increased at 12 months, notably early satiety.
Conclusions:
- BEAM is a feasible endoscopic procedure.
- BEAM appears to induce delayed gastric emptying.
- Delayed gastric emptying is associated with significant weight loss, without gastroparesis symptoms.
