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Endoscopic Sleeve Gastroplasty: A Practice Pattern Survey

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Abstract

Purpose

Obesity is a complex, chronic disease that is strongly associated with complications which cost the US healthcare system billions of dollars per year. Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective procedure for treatment of obesity, but without practice guidelines there are likely to be variations practice. We sought to describe current practice patterns amongst endoscopists who perform ESG to help define areas of focus for future research and guideline development.

Methods

We conducted an anonymous cross-sectional survey to examine practice patterns related to ESG. The survey was organized in 5 sections: Endoscopic Practice, Training, and Resources; Pre-ESG Evaluation and Payment Model; Perioperative/Operative Period; Post-operative Period; and Endobariatric Practice Other Than ESG.

Results

A variety of exclusion criteria were reported by physicians performing ESG. Most respondents (n = 21/32, 65.6%) would not perform ESG for BMI under 27, and 40.6% (n = 13/32) would not perform ESG on patients with BMI over 50. The majority of respondents (74.2%, n = 23/31) reported ESG was not covered in their region, and most reported patients covered residual costs (67.7%, n = 21/31).

Conclusions

We found significant variability with respect to practice setting, exclusion criteria, pre-procedural evaluation, and medication use. Without guidelines for the selection of patients or standards for pre- and post-ESG care, substantial barriers to coverage will remain, and ESG will remain limited to those who can meet out-of-pocket costs. Larger studies are needed to confirm our findings, and future research should be focused on establishing patient selection criteria and standards in practices to provide guidance for endobariatric programs.

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA

    James D. Haddad, Jay D. Horton & Anna Tavakkoli

  2. Division of Endocrinology, University of Texas Southwestern, Dallas, TX, USA

    Jaime P. Almandoz & Jeffrey Schellinger

  3. Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA

    Victoria Gomez

  4. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA

    Allison R. Schulman

  5. Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA

    Jay D. Horton

  6. Department of Molecular Genetics, University of Texas Southwestern, Dallas, TX, USA

    Jay D. Horton

  7. School of Public Health, University of Texas Health Science Center, Dallas, TX, USA

    Sarah E. Messiah & M. Sunil Mathew

  8. Department of Nutritional Sciences, Texas Christian University, Fort Worth, TX, USA

    Elisa Morales Marroquin

Authors
  1. James D. Haddad
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  2. Jaime P. Almandoz
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  3. Victoria Gomez
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  4. Allison R. Schulman
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  5. Jay D. Horton
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  6. Jeffrey Schellinger
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  7. Sarah E. Messiah
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  8. M. Sunil Mathew
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  9. Elisa Morales Marroquin
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  10. Anna Tavakkoli
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Corresponding author

Correspondence to James D. Haddad.

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Conflict of Interest

JDH declares no conflicts of interest.

JPA declares no conflicts of interest.

VG declares no conflicts of interest.

ARS reports compensation as a consultant for Apollo Endosurgery, Boston Scientific, Olympus, and MicroTech, and has received grant/research support funding from GI Dynamics and Fractyl.

JDH declares consultant relationships with Draupnir Bio, Gilead, Merck, Lilly, and Pfizer.

JS declares no conflicts of interest.

SEM declares no conflicts of interest.

MSM declares no conflicts of interest.

EMM declares no conflicts of interest.

AT declares no conflicts of interest.

Ethics Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Key Points

• Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective endoscopic procedure for treatment of obesity and obesity-related conditions.

• No formal guidelines for patient selection, procedural technique, or peri-procedural management exist.

• ESG practitioners have variable practice patterns which may in turn result in heterogenous outcomes.

• These factors contribute to procedural coverage barriers, resulting in substantial out-of-pocket costs to patients and a limited reach to eligible patients with obesity.

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Haddad, J.D., Almandoz, J.P., Gomez, V. et al. Endoscopic Sleeve Gastroplasty: A Practice Pattern Survey. OBES SURG 33, 2434–2442 (2023). https://doi.org/10.1007/s11695-023-06684-2

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  • DOI: https://doi.org/10.1007/s11695-023-06684-2

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