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OUTCOMES OF ENDOSCOPIC SLEEVE GASTROPLASTY VERSUS SLEEVE GASTRECTOMY IN A SAFETY NET HOSPITAL
Benjamin Richter
*, Sameer Rao, Lucie Pham, Cameron M. Erdman, Ritik M. Goyal, Dhvani Doshi, Bao-Ngoc Nasri, Danbee Kim, Daniel B. Jones, Kaveh Hajifathalian
Gastroenterology, Rutgers New Jersey Medical School, Newark, NJ
Obesity is associated with significant morbidity, mortality and healthcare spending, and it disproportionately impacts adults from lower socioeconomic status (SES) backgrounds, with barriers to weight loss including high costs of, and limited insurance coverage for, bariatric procedures. Lower SES adults also may have higher rates of post-Sleeve Gastrectomy (SG) complications. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive intervention in which sutures are placed endoscopically across the stomach to reduce gastric volume. ESG is an effective treatment for obesity that is associated with less substantial weight loss but fewer complications compared to SG, and with reduction in multiple obesity-related comorbidities. It is also cost saving when compared to either Semaglutide or SG. Here, we report our institutional data on ESG and SG.
This is a cohort study of adults who received either LSG or ESG at the primary safety net tertiary care center in New Jersey. Primary outcomes included Total Body Weight Loss % (TBWL%) at 3 months and nadir. SES was characterized using Social Determinants of Health (SDH) data, including the Area Deprivation Index (ADI), a validated scale that ranks New Jersey neighborhoods from 1 (most advantaged) to 10 (least advantaged). Severity of complications were graded using the Clavien-Dindo scale.
47 adults underwent ESG (median age 46.2, 31 women). Mean body mass index was 44.7 (11.6) kg/m2 and mean length of follow up was 347.5 (233.0) days. 79 adults underwent SG (mean age 43.1, 68 women). Mean body mass index was 44.5 (7.3) and mean length of follow-up was 308.5 (194.9) days. There were no statistically significant differences between the ESG and LSG cohorts in baseline BMI, baseline comorbidities, or baseline SDH variables except gender and insurance type. For ESG, Mean TBWL% was 12.7% (5.1) at 3 months and 16.3% (8.8) at nadir. For LSG, mean TBWL% was 14.1 (4.6) at 3 months and 21.8 (8.9) at nadir. Superiority of LSG weight loss over ESG was not statistically significant at 3 months (p = 0.36) but was statistically significant at nadir (p = 0.00). For ESG, 1 complication occurred in 1 adult that was grade 3a on the Clavien-Dindo scale, which was a venous thromboembolism in an adult with a history of blood clots. For LSG, 1 complication occurred in 1 adult that was Grade 3b on the Clavien-Dindo scale, which was post-operative bleeding resulting in 2 blood transfusions given and diagnostic laparoscopy without active bleeding identified. There were no statistically significant differences between ESG and LSG for rate of significant complications.
Both ESG and SG can feasibly be performed in a safety net hospital. While SG exhibited greater weight loss than ESG, both resulted in clinically significant weight loss. Individualized selection is needed to determine who might benefit most from each procedure.
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