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REVISIONAL ENDOSCOPIC SLEEVE GASTROPLASTY FOR WEIGHT RECIDIVISM AFTER SLEEVE GASTRECTOMY IN ADULTS OF LOWER SOCIOECONOMIC STATUS
Benjamin Richter
*, Lucie Pham, Sameer Rao, mohammed ayyad, Daniel B. Jones, Bao-Ngoc Nasri, Danbee Kim, Ahmed Al-Khazraji, Suut Gokturk, Kaveh Hajifathalian
Gastroenterology, Rutgers New Jersey Medical School, Newark, NJ
Introduction:
Significant weight recidivism after sleeve gastrectomy (SG) occurs in a subset of adults, for which lower socioeconomic status (SES) is an important risk factor. Adults from lower SES backgrounds who undergo SG also tend to have higher rates of post-operative complications. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive intervention that is associated with shorter hospital stays and fewer complications compared to SG, has demonstrated efficacy for managing obesity, is cost-effective compared to SG, and has some data supporting efficacy for managing weight regain after SG. For these reasons, we hypothesized that ESG may be an optimal intervention for weight regain and weight loss plateau post-SG, particularly in adults of lower socioeconomic status.
Methods:
This was a case series of 11 adults who underwent revisional endoscopic sleeve gastroplasty after sleeve gastrectomy. Socioeconomic status was characterized using race, health insurance quality, and the Area Deprivation Index for the state of New Jersey, an index that ranks neighborhood-level socioeconomic disadvantage on a scale from 1 (most advantaged) to 10 (least advantaged).
Results:
All 11 adults successfully underwent ESG at a median of 85.6 (55.3 - 107.6) months post-SG. Adults were predominantly female (10/11, 90.9%), with a median age of 46.2 (41.3 - 52.8) years at time of ESG. Eight (72.7%) adults identified as Black race and three (27.2%) as Other race; nine (81.8%) adults were on Medicaid, one on Medicare (9.1%), and one on private insurance (9.1%); median ADI was 8 (5.5 - 8.8). Ten adults experienced a median of 23.6 (18.1 - 34.9) kg of weight regain from post LSG nadir weight. One patient experienced weight loss plateau prompting ESG. The median body mass index was 42.5 kg/m2 at the time of ESG. Median follow-up after ESG was 14.3 (4.1 - 22.9) months. Median total body weight loss percent (TBWL%) was 12.4% (9.4% -14.1%) at end of follow-up. ?10% TBWL was achieved by 8 out of 11 (72.6%) adults at end of follow up. Three post-op complications occurred in seven adults, including VTE (n = 1), AKI (n = 1), and vomiting (n = 6). No complications exceeded grade 3b on the Clavien-Dindo scale.
Conclusion:
Revisional ESG after SG is a safe and effective approach to weight loss recidivism, particularly in adults of lower socioeconomic status.
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