Tu1914 PRACTICE PATTERNS IN BARIATRIC ENDOSCOPY: A SURVEY OF THE MEMBERS OF THE ASSOCIATION FOR BARIATRIC ENDOSCOPY

Abstract

A wide range of endoscopic bariatric technologies (EBT) have been introduced in the United States in the past two years with many others in various phases of development. Endoscopic bariatric procedures have demonstrated safety and efficacy in achieving weight loss in conjunction with diet and lifestyle interventions in a clinical trial setting. Limited data exists on the adoption of EBT in clinical practice. To report current practice patterns and perceived barriers to wider adoption of EBT among members of the Association for Bariatric Endoscopy (ABE). All members of the ABE were invited to complete an anonymous electronic survey of domains relevant to knowledge, practice patterns and barriers to wider adoption of EBT. Participants were queried on the following: a) personal and practice demographics b) familiarity with current availability of EBT, c) practice patterns in EBT, d) barriers to wider adoption of EBT. Content validity was established by survey review by 4 experts in EBT. The survey response rate was 5.8% (28/480). The majority of responders had been in practice for >10 years (57.1%), were gastroenterologists (92.8%) and were in private practice (78.5%). Eighty two percent of responders performed >50 endoscopic procedures per month and a majority (60.7%) performed ERCP; 32.1% had been involved in pre-approval studies of EBT. Sixty percent of responders offered medical weight management in their practice and 39.3% prescribed weight loss medications. A majority of responders received education and training in EBT from the ABE (75%) as well as industry (71.4%) and rated there familiarity with EBT as 8.6±18.3 on a 10 cm VAS scale. Table 1 describes EBT practices among responders. The EBT most frequently offered was Orbera® intragastric balloon (IGB) (57.1%), while Aspire Assist® was the least utilized EBT (10.7%). Endoscopic sleeve gastroplasty and transoral outlet reduction were offered by 35.7%. In the 12 months prior to the survey, 35.7% of responders had performed NO endoscopic bariatric procedures, while 25% had performed >20. The most frequently cited barrier to wider adoption of EBT was lack of insurance reimbursement/cost (85.7%), followed by lack of physician awareness (50%). Members of the ABE are familiar with the available EBT, and most obtain education and training in EBT from professional societies and industry. Intragastric balloons are currently the most widely utilized EBT. Despite enthusiasm from physicians and professional societies, EBT volumes among responders are low, with 36% having performed NO endoscopic bariatric procedures in the past 12 months. Lack of insurance reimbursement/cost is felt to be the most significant barrier to wider adoption of EBT.Tabled 1Table 1: Baseline demographics and EBT practice patternsYears in practice<59 (32.1%)5-103 (10.7%)>1016 (57.2%)How do you obtain education about EBTASGE/ABE21 (75%)Industry20 (71.4%)Other professional society7 (25%)Perform ERCP17 (60.7%)Offer medical weight management17 (60.7%)Prescribe weight loss medications11 (39.3%)EBT Offered in PracticeOrbera IGB16 (57.1%)ReShape Duo IGB5 (20.8%)Obalon IGB4 (16.7%)Aspire Assist3 (12.5%)Endoscopic sleeve gastroplasty10 (41.7%)Volume Endoscopic Bariatric Procedures in the past 12 monthsNone10 (35.7%)10-2011 (39.3%)>207 (25%)Barriers to wider adoption of EBT in your practicePatient awareness11 (39.3%)Physician awareness14 (50%)Poor weight loss efficacy7 (25%)Concern for complications8 (28.6%)Lack of insurance coverage/cost24 (85.7%)Lack of infrastructure for weight loss program12 (42.9%) Open table in a new tab