Six-month comparative outcomes of endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: an MBSAQIP analysis

BACKGROUND: North American data regarding long-term efficacy and durability of endoscopic sleeve gastroplasty (ESG) are remarkably scarce outside of clinical trial settings hampering our understanding of its optimal role in the obesity care continuum. The aims of this study are to compare safety and efficacy of elective ESG versus laparoscopic sleeve gastrectomy (LSG) at 6 months using accredited MBSAQIP centers. METHODS: Data were obtained from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for 2023 and merged with the 6‑month follow‑up data file. The primary objectives of the study were to characterize the long-term six-month changes in weight and metabolic comorbidities of ESG patients in contrast to their LSG counterparts. Logistic regression models were to evaluate for differences in six-month serious complications and emergency department readmissions between ESG and LSG. RESULTS: A total of 115,476 patients were included, comprising 114,967 LSG and 509 ESG procedures. Patients undergoing ESG were slightly older (44.5 ± 11.2 vs. 42.4 ± 11.9 years, p = 0.0001) and had lower baseline BMI (40.9 ± 8.6 vs. 45.0 ± 7.8 kg/m², p < 0.0001) and mean body weight (113.2 ± 28 vs. 124.5 ± 26.3 kg). At 6 months, LSG resulted in greater weight reduction, with larger BMI loss (8.2 ± 10.8 vs. 3.9 ± 12.0 kg/m², p < 0.0001), and total weight loss (22.6 ± 35.6 vs. 11.1 ± 37.7 kg, p < 0.0001). For patients undergoing LSG, there was a near 50% reduction in medication/insulin-dependent diabetes along with improvements in rates of dyslipidemia, hypertension, and sleep apnea. Importantly, no clinically meaningful comorbidity improvements from baseline to 6 months were seen following ESG. CONCLUSION: When compared to ESG at 6 months, LSG provides an improvement in total body weight loss, has a reduced operative time, and is associated with dramatic metabolic comorbidity improvement including a reduction in resolution of medication and insulin-dependent diabetes. No clinically meaningful comorbidity resolution was seen in patients receiving ESG compared to LSG at 6 months although this cohort was less comorbid at baseline.