C0453 - Early Safety and Efficacy of Endoscopic Sleeve Gastroplasty vs Sleeve Gastrectomy: A Propensity-Matched, Database Analysis of 6,000 Patients

Anuragh Gudur, MD, Calvin Geng, MD, Sonia Kshatri, MD, David Martin, PhD, Rebecca Haug, MD, Mark Radlinski, MD, Yang Lei, MD, Ross Buerlein, MD, Daniel Strand, MD, Bryan G. Sauer, MD, MSc, Vanessa Shami, MD, Andrew Wang, MD, Alexander Podboy, MD
University of Virginia, Charlottesville, VA

Introduction: Endoscopic sleeve gastroplasty (ESG) is a promising bariatric intervention designed to emulate sleeve gastrectomy (SG), the most commonly performed bariatric operation. Comparative studies are limited and there is a lack of large-scale population-based data. Additionally, no studies have examined the impact of race on outcomes after ESG. This is the largest study yet to compare short-term safety and efficacy of ESG to SG, and the first to evaluate the impact of race on short-term outcomes after ESG.

Methods: We analyzed 600,000 patients who underwent ESG or SG from 2016-2020 across over 800 hospitals in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Patients who underwent ESG were propensity matched to SG patients. We primarily compared occurrences of adverse events (AE), readmissions, reoperations, and reinterventions within 30-days. Secondary outcomes measured at 30 days included total body weight loss (TBWL), outpatient treatments for dehydration, and emergency room (ER) visits. Multivariate regression evaluated the impact of patient characteristics, including race, on AE.

Results: 6,054 patients underwent ESG and 597,463 underwent SG. Propensity matching in a 1:5 ratio compared all ESG cases to 30,270 SG cases. ESG had shorter procedural time (62.9 min vs 72.4, p < .05) and length of stay (0.87 days vs 1.45, p< 0.05). AE were low after both procedures (SG: 1.1% vs ESG: 1.4%, p > 0.05). However, patients undergoing ESG had more readmissions (3.8% vs 2.6%), reoperations (1.4% vs 0.8%), and reinterventions (2.8% vs 0.7%) within 30 days (p < 0.05). SG cohort had more outpatient treatments for dehydration (3.3% vs 2.4%, p< 0.05) and ER visits not resulting in admission (5.9% vs 4.9%, p< 0.05). SG also resulted in greater mean %TBWL compared to ESG (5.4% vs 4.0%, p< 0.05). The greatest odds of increasing AE after both ESG and SG were attributed to the presence of renal insufficiency (ESG: OR 10.0, SG: OR 1.95) and therapeutic anticoagulation (ESG: OR 3.73, SG: OR 1.80). Race was not significantly associated with AE after ESG, while black race was associated with higher risk of AE after SG (OR 1.23, 95% CI: 1.13-1.35).

Discussion: ESG demonstrates comparable safety to SG with shorter procedure time and LOS. Clinicians may have been more inclined to readmit and intervene in ESG patients as compared to SG patients with similar complaints. Race did not impact short-term AE after ESG. Further prospective comparative studies are needed.



Disclosures:


Anuragh Gudur, MD, Calvin Geng, MD, Sonia Kshatri, MD, David Martin, PhD, Rebecca Haug, MD, Mark Radlinski, MD, Yang Lei, MD, Ross Buerlein, MD, Daniel Strand, MD, Bryan G. Sauer, MD, MSc, Vanessa Shami, MD, Andrew Wang, MD, Alexander Podboy, MD. C0453 - Early Safety and Efficacy of Endoscopic Sleeve Gastroplasty vs Sleeve Gastrectomy: A Propensity-Matched, Database Analysis of 6,000 Patients, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.