S1067 Endoscopic Sleeve Gastroplasty vs Intragastric Balloon: A Large, Database Analysis of Early Safety and Efficacy

Abstract

Introduction: Intragastric balloon (IGB) placement and endoscopic sleeve gastroplasty (ESG) are the two most common endoscopic bariatric therapies currently performed in the United States. Procedural selection is often based primarily on patient preference. There is a lack of comparative data to help guide patient discussions regarding these interventions. This study is the largest study to date to directly compare short-term safety and efficacy of IGB to ESG using a large international bariatric database. Methods: All patients undergoing ESG and IGB across 800 hospitals in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2016-2020 were included. All patients undergoing IGB were propensity matched to patients undergoing ESG. We compared occurrences of serious adverse events (SAE), readmissions, re-interventions, and emergency room (ER) visits within 30-days after procedure. Secondary outcomes included procedure time, length of stay (LOS), and total body weight loss (TBWL) measured at 30 days. (Table) Results: A total of 1,996 patients underwent IGB and 6,054 patients underwent ESG. All IGB patients were propensity matched to 1,996 ESG patients, with no differences in baseline characteristics. ESG and IGB had similarly low rates of SAE (p > 0.05). ESG had more readmissions within 30 days (p< 0.05). IGB had more outpatient treatments for dehydration and re-interventions within 30 days (p< 0.05), with 3.7% of patients reporting early balloon removal less than 30 days after implantation. ESG had greater %TBWL at 30 days (p< 0.05). Conclusion: ESG and IGB are both safe procedures with comparably low rates of SAE. ESG is perhaps better tolerated than IGB. Table 1. - ‡ Most common reason for readmission after both procedures was nausea, vomiting, and fluid/electrolyte or nutritional depletion. § Most common type of intervention after IGB was early IGB removal. The most common intervention after ESG was therapeutic endoscopy with stent placement or dilatation Comparing Short Term (30d) Procedural Outcomes of Endoscopic Sleeve Gastroplasty and Intragastric Balloon Placement ESG (n=1998) IGB (n=1998) p Mean BMI (SD) 36.36 (6.19) 36.17 (6.16) 0.316 Mean Change from Pre-Op to Post-Op BMI (SD) -1.51 (2.41) -0.95 (2.83) < 0.001 Mean % Total Body Weight Loss (%TBWL) (SD) 3.8% (7.9%) 2.3% (6.6%) < 0.001 Mean Number of Days from Procedure to Discharge (SD) 0.65 (1.76) 0.04 (0.33) < 0.001 Mean Procedure Length, minutes (SD) 64.97 (45.39) 16.51 (17.12) < 0.001 Serious Adverse Event, n (%) 17 (0.9) 5 (0.3) 0.055 Reoperation, n (%) 22 (1.1) 12 (0.6) 0.121 Readmission, n (%) ‡ 56 (2.8) 29 (1.5) 0.004 Re-Intervention, n (%) § 35 (1.8) 90 (4.5) < 0.001 Received Treatment for Dehydration Outpatient, n (%) 46 (2.3) 89 (4.5) < 0.001 Emergency Department Visit Not Resulting in Admission, n (%) 66 (3.3) 69 (3.5) 0.861