Endoscopic Sleeve Gastroplasty is an Effective Treatment for Obesity in a Veteran With Metabolic and Psychiatric Comorbidities.

Background: Obesity is a chronic disease associated with several metabolic comorbidities. Weight loss interventions, such as bariatric surgery and endoscopic procedures like endoscopic sleeve gastroplasty (ESG), are known to improve obesity-related health conditions. However, there is limited data on the impact of endoscopic procedures on psychiatric disorders. Our report aims to describe the clinical course of a veteran with psychiatric comorbidities that prevented him from proceeding with bariatric surgery, and ultimately underwent an ESG.

Case presentation: A 59-year-old male veteran with severe obesity had limited exercise capability and poor quality of life due to a large ventral hernia. The patient's dietary, lifestyle modification, and medication-assisted weight loss attempts were unsuccessful. A planned weight loss surgery was canceled due to anxiety and a panic attack. He underwent ESG with a successful total body weight loss of 16.7% at 12 months. Subsequent improvement in metabolic and psychiatric comorbidities ultimately enabled the patient to undergo ventral hernia repair, which significantly improved his quality of life.

Conclusions: This report demonstrates that ESG may be an option for weight loss in patients with psychiatric comorbidities and can lead to significant clinical improvement in multiple obesity-associated comorbidities. This case further highlights the value of endoscopic procedures as alternatives to bariatric surgery in select cases when lifestyle changes and medications have not been effective, and surgery may not be a viable option.