SSAT Home  |  Past Meetings
Society for Surgery of the Alimentary Tract

Back to 2020 Abstracts


CURRENT PERSPECTIVES OF BARIATRIC ENDOSCOPISTS ON ENDOSCOPIC SLEEVE GASTROPLASTY (ESG)
Dilhana Badurdeen*1, Lea Fayad1, Abdellah Hedjoudje2, Mohamad I. Itani1, Jad Farha1, Cem Simsek1, Anthony N. Kalloo1, Mouen A. Khashab1, Manoel Galvao Neto3, Aayed Alqahtani4, Vivek Kumbhari1
1The Johns Hopkins Hospital, Baltimore, MD; 2CHRU Jean Minjoz, Besançon, France; 3Florida International University, Miami, FL; 4New You Medical Center , Riyadh, Saudi Arabia

Background:
An increasing number of endoscopists are performing Endoscopic Sleeve Gastroplasty (ESG) worldwide. Since the first procedure in 2013, approximately 10,000 procedures have been performed globally. There is variation in pre- and post-procedure management, as well as the procedure itself. Lack of a published consensus amongst experts may have a potential negative impact on outcomes, teaching and research.

Methods:
A 45-question survey was completed by participants at the Association of Bariatric Endoscopy (ABE) meeting, a division of the American Society of Gastrointestinal Endoscopy, at Digestive Disease Week (DDW) in May 2019. The survey investigated 1) Technical aspects of ESG, 2) Peri-operative management and 3) Training.

Results:
Of the 50 participants that completed the survey 29 (58%), perform ESG. The majority 18 (62%) had completed 0-50 procedures. Two (7%) responders had performed more than 1000 ESGs. 15 (52%) considered themselves experts at performing ESG and of these respondents, 8 (53%) felt that 1-20 procedures were sufficient to become an expert. 35 (70%) responders were Gastroenterologists and 44 (88%) worked in a multidisciplinary setting whilst 37 (74%) offered other bariatric procedures. 21 participants (72%) had experience with endoscopic suturing prior to offering ESG and 16 (57%) trained in a structured program. Amongst the 16 participants who were planning to perform ESG in the future only 2 (12%) were planning to apply to a structured training program, 9 (56%) were planning for training through mentors, ASGE and industry sponsored courses and 5 (31%) were undecided.
34% felt that the indication for ESG based on BMI should be 30-40kg/m2; whilst 62% felt, Asians and Arabs should have a lower cut off at 27.5-33.5 kg/m2. There was no apprehension performing ESG in patients with a BMI >50 kg/m2, previous gastric band or intra-gastric balloon and weight regain post-laparoscopic sleeve gastrectomy.
There was no consensus on pre- and post-operative medication regimens for nausea and pain, but the majority thought that ASGE guidelines should be followed for stopping anti-coagulation and anti-platelet medications in endoscopic submucosal dissection patients prior to ESG. Most recommended post procedure proton pump inhibitor once daily for 4 weeks 12(44%). The average number of sutures used was 5-8 (50%) and the most popular suture pattern was the ā€˜Uā€™ shape 12 (50%). The majority felt that the fundus should not be sutured (71%). A post procedure antibiotic regimen was recommended by 83 % though there was no consensus on dose or route.

Conclusion:
There is variation of technique, peri-operative management and training for ESG. It is imperative to establish a consensus for training and research as ESG becomes more widespread.

Table 1: ESG Survey


Back to 2020 Abstracts