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QUALITY IMPROVEMENT: USE OF PRE-PROCEDURE GROUP INTERVENTIONS SUPPORT WEIGHT LOSS OUTCOMES IN BARIATRIC ENDOSCOPY PROGRAM
Erika Staneff, Bailey Flora
*, Leandro Sierra, Renan Prado, Arjun Chatterjee, Stephen A. Firkins, Roma Patel, Akash T. Khurana, Roberto Simons-Linares
Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH
Introduction: Pre-operative behavioral and nutritional interventions are commonly utilized to optimize patients’ lifestyle prior to endoscopic bariatric procedures. Patient adherence to lifestyle changes that align with weight loss and post-bariatric procedures are assessed during the pre-procedure evaluation. Patients identified with behavioral or nutritional needs are referred to group intervention. The purpose of this study was for quality improvement and to assess the effectiveness of optimizing patient for bariatric endoscopy procedures and how such preparation would impact weight loss post-procedure.
Methods: Among 467 patients enrolled in our bariatric endoscopy program, we performed a quality improvement study assessing the impact of combination psychology and nutrition groups visits (PNGV) on total weight loss whom group participants undergoing bariatric endoscopy procedures including transoral outlet reduction (TORe), endoscopic sleeve-in-sleeve (SIS), and endoscopic sleeve gastroplasty (ESG). Patients were identified as benefiting from multidisciplinary group interventions based on clinical evaluations conducted by both the team psychologist and dietitian. When poor adherence to nutrition and behavioral changes encouraged for weight loss and bariatric procedures were identified, the patient was referred to the multidisciplinary group intervention. We included patients in the groups who were pursuing TORe, ESG, SIS, intragastric balloon (IGB).
Results:The majority of patients (78.2%) attended multiple PNGVs, while 21.8% had no attendance. Those who attended more frequently were older on average (51.7 vs. 47.0 years). The mean number of attendances was 2.7, with a maximum of 4. Among multi-group attendees, TORe was the most common procedure (45%), while the zero-attendance group had an equal distribution of TORe, ESG, and SIS. ESG and TORe procedures were linked to higher weight loss percentages (Figure 1a). The intervention did not significantly affect total weight loss, either when stratified by week or nadir over the 18-month follow-up period. However, patients attending multiple groups showed a trend toward greater weight loss (Figure 1b). A higher number of pre-psychology and pre-dietitian visits was significantly associated with greater total weight loss (P < 0.001) table 1. Pearson correlation did not reveal a strong association between weight loss and the number of groups attended (r=0.35).
Conclusions:
This study found that more psychology and dietitian visits prior to bariatric endoscopy procedures correlates with higher total weight loss independent of patients participating in combination psychology and dietitian group appointments. Bariatric endoscopy programs should be encouraging a higher number of visits with psychologists and dietitians prior to bariatric endoscopy procedures to achieve better weight loss outcomes.
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