Endoscopic Sleeve Gastroplasty: A Safe Bariatric Intervention for Class III Obesity (BMI > 40)

Jan 30, 2023Obesity surgery

Endoscopic Sleeve Gastroplasty as a Safe Weight-Loss Procedure for Severe Obesity (BMI over 40)

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Abstract

Among ESG patients, those with BMI > 40 achieved greater total body weight loss (TBWL) at 30 days compared to those with BMI 30-40.

No differences in adverse events, readmissions, or re-interventions were observed between ESG patients with BMI > 40 and those with BMI 30-40.
Endoscopic sleeve gastroplasty (ESG) demonstrated similar adverse event rates compared to sleeve gastrectomy (SG) and lower rates than gastric bypass (RYGB).
ESG produced comparable total body weight loss at 30 days when compared to both SG and RYGB.
The safety and feasibility of ESG in patients with class III obesity (BMI > 40) are similar to those in patients with class I and II obesity.

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PURPOSE: Endoscopic sleeve gastroplasty (ESG) is primarily offered to patients with class I and II obesity (BMI 30-40), although there are no guidelines specifying applicability. There is little data comparing ESG to bariatric surgery in patients with class III obesity (BMI > 40). This study evaluates the short-term safety of ESG compared to sleeve gastrectomy (SG) and gastric bypass (RYGB) in patients with class III obesity.

METHODS: We retrospectively analyzed over 500,000 patients who underwent ESG, SG, and RNYGB from 2016 to 2020 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. ESG patients were stratified by BMI to compare outcomes between class I and II versus class III obese patients. Class III obese patients who underwent ESG were also propensity matched to SG and RNYGB patients for matched comparisons. Primary outcomes included adverse events (AE), readmissions, re-operations, and re-interventions within 30 days. Secondary outcomes included procedure time, length of stay (LOS), and total body weight loss (%TBWL) at 30 days.

RESULTS: Among ESG patients, those with BMI > 40 had no difference in AE, readmissions, or re-interventions versus patients with BMI 30-40 (p > 0.05), while achieving greater %TBWL at 30 days (p < 0.05). In comparison to surgery, ESG had similar AE to SG and less than RNYGB, while producing comparable %TBWL to SG and RNYGB at 30 days.

CONCLUSIONS: The feasibility and safety of ESG in patients with class III obesity are comparable to patients with class I and II obesity. Additionally, the safety of ESG in patients with class III obesity is comparable to SG and safer than RYGB. Endoscopic sleeve gastroplasty: a safe bariatric intervention for class III obesity (BMI > 40).

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Endoscopic Sleeve Gastroplasty: A Safe Bariatric Intervention for Class III Obesity (BMI > 40)

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