Practice patterns and outcomes of endoscopic sleeve gastroplasty based on provider specialty

Abstract

Background Endoscopic sleeve gastroplasty (ESG) is performed in clinical practice by gastroenterologists (GI) and bariatric surgeons. Given the increasing regulatory approval and global adoption, we aim to evaluate real-world outcomes in multidisciplinary practices involving bariatric surgeons and GIs across the United States. Methods We included adult patients with obesity who underwent ESG from January 2013 to August 2022 in seven academic and private centers in the US. Patients and procedural characteristics, serious adverse events (SAEs), and weight loss outcomes up to 24 months were analyzed. SPSS (version 29.0) was used for all statistical analyses. Results 1506 patients from 7 sites included 235 (15.6%) treated by surgeons and 1271 (84.4%) treated by GIs. There were no baseline differences between groups. GIs used APC for marking significantly more often than surgeons (p<0.001). Surgeons placed sutures in the fundus in all instances whereas GIs placed them in the fundus in less than 1% of the cases (p<0.001). Procedure times were significantly different between groups, with surgeons requiring approximately 20 minutes additionally during the procedure, compared to GIs (p<0.001). %TWBL and % responders achieving >10 and > 15% TBWL were similar between the two groups at 12, 18, and 24 months. SAEs were low and similar at 1.7% for surgeons and 2.7% for GIs (p>0.05). Conclusion Data from a large US cohort show significant and sustained weight loss with ESG and excellent safety profile in both bariatric surgery and GI practices, supporting the scalability of the procedure across practices in a multidisciplinary setting.