Society for Surgery of the Alimentary Tract
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Julia R. Amundson*1,2, Kristine Kuchta1, Vanessa N. VanDruff1,2, Stephanie Joseph1, Simon Che1, Christopher J. Zimmermann1, Shun Ishii1, H M. Hedberg1, Michael Ujiki1
1General Surgery, NorthShore University HealthSystem, Evanston, IL; 2University of Chicago Division of the Biological Sciences, Chicago, IL

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive intervention to address obesity and associated comorbidities. Previous studies have shown variable outcomes following bariatric surgery for patients who are privately insured, publicly insured, or self-pay. Differences include higher excess weight loss (%EWL) and earlier loss to follow up in self-pay patients, with variability in comorbidity resolution and complications. In this study we aim to review our institutional outcomes following ESG by payer.

A retrospective review of a prospective bariatric quality database included all patients who underwent ESG between 6/2016 and 10/2022 at a single institution. Post-procedure outcomes, including %EWL, comorbidity resolution, and complications were collected and compared by payer status. Group comparisons were made using two-tailed Wilcoxon rank-sum and Fisher's exact test.

During the study period, 57 patients underwent ESG; 22 (38.6%) were insured and 35 (61.4%) were self-pay. Of the 22 insured patients, 16 (72.7%) were MERIT trial participants and 6 (27.3%) were privately insured. There were no significant demographic differences between the three groups, including starting BMI. Comorbidities differed in more hypertensive trial patients compared to privately insured patients (56.3% vs 0%, p=0.027) and more diabetic trial patients compared to self-pay or privately insured patients (37.5% vs 8.6% vs 0%, p=0.025). Preoperative rates of smoking, hyperlipidemia, obstructive sleep apnea and GERD did not differ significantly between groups. There were no significant differences in number of endosutures, OR time, estimated blood loss, length of stay, postoperative hemorrhage, return to OR, or 30-day outcomes including ED visits, readmission, death, or treatment for dehydration between groups. Trial participants had significantly longer median follow-up at 29 months compared to 9 months for private insurance and 6 months for self-pay, p=0.001. Median %EWL was greater in insured patients (n=4, all MERIT trial) compared to self-pay patients (n=4) at the 4-year postoperative timepoint only (-39.2±20.6% vs +9.4±14.0%, p=0.021). Self-pay patients had weight regain beyond consultation weight at the 4-year postoperative timepoint [Fig 1]. There were no statistically significant differences in HbA1c, diabetes, obstructive sleep apnea, GERD, hyperlipidemia, or hypertension between groups at 6-month, 1-year, 2-year, or 3-year postoperative timepoints.

Following ESG, excess weight loss is sustained up to 2-years postop regardless of payer, and up to 4-years postop in insured patients. Differences in %EWL by payer may include more sustained %EWL at 4-year postop in insured patients than in self-pay patients.

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