890 The Impact of Multidisciplinary Evaluation Before and After Endoscopic Sleeve Gastroplasty on Weight Loss and Quality of Life

Abstract

INTRODUCTION: Endoscopic sleeve gastroplasty (ESG) is a relatively novel endoscopic procedure that reduces the gastric lumen with proven less complications and almost same 6 months weight loss compared to laparoscopic sleeve gastroplasty (LSG). To our knowledge there are no trials investigating the role of multidisciplinary evaluation (ME) before and after ESG. The aims of the present study were to evaluate the role of ME prior and after ESG in terms of weight loss outcomes, quality of live improvements and adverse events. METHODS: From May 2016 to April 2019 all patients that underwent ESG were retrospectively evaluated from a prospective database. Included patients had 2° and 3° degree of obesity or 1° with comorbidities. All patients underwent upper GI endoscopy to exclude pathologies. Until September 2017 before ESG only psychiatric evaluation was requested (group 1), while after this date we adopted the guidelines of the Italian Society for Obesity Surgery and all patients were evaluated on a multidisciplinary team composed by gastroenterologist, surgeon, psychiatrist, endocrinologist and dietitian (group 2). We compared this two groups in terms of Excess Weight Loss (%EWL), Total Body Weight Loss (%TBWL) and quality of life improvements, measured with the Bariatric Analysis and Reporting Outcome System (BAROS). ESG was done with the Apollo Overstitch suturing system (Apollo Endosurgery) and a double channel gastroscope Olympus 2TGIF-160 (Olympus Japan) in general anesthesia and with insufflation of CO2. All patients had ambulatory visit t 1, 3, 6 and 12 months after ESG. Statistical analysis was done with chi-square test and < 0.05 value was considered significant. The study was approved by the local Ethical Committee (N° 19211/18). RESULTS: A totally of 89 ESG were performed. Group 1 consisted of 11 patients while Group 2 of 78. Mean procedure time was 51 minutes (range 28-92). Mean number of stitches were 4.7/patient (range 3-8). No procedure related complications were observed. Female were 56 patients; mean age was 45.4 (range 23-73). Mean BMI at inclusion was 41.6 (range 31.6-62.4). Mean %EWL and %TBWL at 12 months was 37.6 and 15.6 respectively (Table 1). Comparing the two groups there was significant (P < 0.05) difference in terms of %EWL, %TBWL and BAROS scale (Table 2) for all periods of follow-up, with better results in group 2. CONCLUSION: ME before and after ESG has a fundamental role in terms of better procedure outcomes for both weight loss and quality of live in obese patients.