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

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Abstract

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.

Graphical Abstract

Endoscopic sleeve gastroplasty: a safe bariatric intervention for class III obesity (BMI > 40)

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Data Availability

All data, analytic methods, and study materials are available to other researchers upon request of the Metabolic and Bariatric Surgery Association Quality Improvement Program.

Abbreviations

AE:

Adverse events within 30 days postprocedure

ESG:

Endoscopic sleeve gastroplasty

MBSAQIP:

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

RYGB:

Roux-en-Y gastric bypass

SG:

Sleeve gastrectomy

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Authors and Affiliations

  1. Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA, 22901, USA

    Anuragh R. Gudur & Calvin Geng

  2. Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, 22901, USA

    Mark Radlinski, Vanessa M. Shami, Andrew Y. Wang & Alexander Podboy

  3. Department of Surgery, University of Virginia, Charlottesville, VA, 22903, USA

    Zequan Yang

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  1. Anuragh R. Gudur
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Conflict of Interest

Dr. Vanessa Shami is a consultant for Olympus Medical and Cook Medical. Other co-authors do not have any conflicts of interest to disclose.

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Keypoints

• This is one of the few studies evaluating ESG in class III obesity.

• Adverse events (AE) remained low after ESG, including patients with BMI > 40.

• ESG had similar AE to bariatric surgery (SG, RYGB) in class III obesity.

Supplementary Information

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Supplementary file1 (DOCX 33 KB)

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Gudur, A.R., Geng, C., Radlinski, M. et al. Endoscopic Sleeve Gastroplasty: A Safe Bariatric Intervention for Class III Obesity (BMI > 40). OBES SURG 33, 1133–1142 (2023). https://doi.org/10.1007/s11695-023-06475-9

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