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TRENDS AND OUTCOMES OF ENDOSCOPIC SLEEVE GASTRECTOMY BASED ON PROCEDURALIST TYPE
David J. Leishman
*1, Zachary Leslie
2, Sayeed Ikramuddin
1, Eric Wise
11Surgery, University of Minnesota, Minneapolis, MN; 2Carleton College, Northfield, MN
Introduction:Endoscopic sleeve gastroplasty (ESG) is a restrictive bariatric therapy introduced in the last decade during which endoscopic plication of the greater curvature reduces effective stomach volume. It is performed by surgeons and gastroenterologists (GI), specialists, each with significant training background differences. As ESG achieves greater adoption throughout the country, differences in outcomes between these specialist groups are unknown and may have impacts on both safety and efficacy. Therefore, the aim of this study is to provide a preliminary look at outcome differences for ESG performed by surgeons or GI.
MethodsThis was a retrospective study of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Accredited MBS centers enter all surgical and endoscopic bariatric interventionsinto this database; variable changes for the 2020 and subsequent datasets enabled more accurate identification of patients undergoing ESG. Using CPT code 43999 and subsequently searching for the procedure description "endoscopic gastroplasty", the MBSAQIP database was queried from 2020-2023 to identify patients who had undergone ESG, and these were stratified by surgeon or GI proceduralist. Demographics and patient characteristics were analyzed. Logistic regression analysis was performed for the primary outcome of 30-day readmission with surgeons as the proceduralists as an independent variable. Secondary outcomes included length of stay (LOS), operation length, mortality, and need for transfusion post-operatively with p<0.05 as the threshold for statistical significance.
Results2,190 patients underwent ESG, with similar numbers performed by surgeons (n=1,099) and GI (n=1,091). The average age of patients undergoing ESG by surgeons was 44.78 (SD 10.0) versus 45.48 (SD 11.3) years for GI with both having 86.4% female patients. Adverse events and reoperations were low for both groups; therefore logistic regression was not performed. Odds of readmission (30-day) were lower for surgeons than GI (0.29 [0.15, 0.57], p<0.05]. Surgeons demonstrated significantly lower LOS and procedural time. There were no mortalities (Table 1).
ConclusionESG appears to be a safe bariatric therapy when performed by surgeons or GI. Surgeons had decreased odds of readmission, and shorter length of stay and procedural time. The number of ESG remains relatively low relative to surgical sleeve gastrectomy, a trend that may change as longer term safety and weight loss outcomes are borne out.
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