No significant differences in 30-day serious complications between ESG and LSG, but ESG associated with decreased ED utilisation

There are no significant differences in rates of 30-day serious complications between endoscopic sleeve gastroplasty (ESG) and laparoscopic sleeve gastrectomy (LSG) however, ESG was associated with decreased odds of emergency department (ED) utilisation, researchers from the University of Virginia, Charlottesville and the Cleveland Clinic, Cleveland, have reported. They stated that the findings highlight the need for further prospective investigations comparing the two procedures to better inform bariatric interventions and selections to optimise perioperative outcomes, safety and healthcare costs.

The researchers undertook the study to address the current gaps in ESG literature and using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to characterise the modern prevalence, trends and clinical characteristics of ESG patients versus those receiving laparoscopic sleeve gastrectomy. Secondary objectives were to describe and evaluate for differences between 30-day outcomes, including emergency department utilisation, outpatient intravenous (IV) rehydration therapy and overall serious complications.

All elective primary ESG and LSG between 2020 and 2023 were identified in this retrospective cohort study, with a total of 506,597 patients met inclusion criteria, - 2,285 patients receiving ESG and 504,312 receiving LSG. ESG patients were younger (42.6 ± 11.8 years ESG vs. 45.1 ± 10.7 years LSG p<0.0001), had a lower BMI (39.5 ± 7.5 kg/m2 ESG vs. 44.9 ± 7.7 kg/m2 LSG; p<0.0001), and had a female predominance (86.2% ESG vs. 81.5% LSG; p<0.0001).

Patients who underwent ESG also had an overall reduced metabolic disease burden, with a reduced prevalence of sleep apnoea (17.6% ESG vs. 35.0% LSG; p<0.0001), insulin and medication-dependent diabetes (12.4% ESG vs. 20.6% LSG; p<0.0001), hypertension (30.8% ESG vs. 42.0% LSG; p < 0.0001), and dyslipidemia (14.4% ESG vs. 20.9% LSG; p<0.0001).

The found that the numbers for both procedures increased from 2020 to 2022 until a peak of 141,284 cases in the 2022 year, with a total of 691 ESGs performed. Both LSG (n=130, 111, 25.8%) and ESG (n=567, 24.8%) case volumes dropped in the following 2023 operative year.

Unsurprisingly, operative length for ESG cases was significantly longer than LSG (81.2 ± 48.3 min ESG vs. 69.3 ± 36.0 min LSG p<0.0001), although days in hospital following the procedure were significantly longer for the LSG cohort (1.21 ± 0.97 days LSG vs. 0.19 ± 0.92 days ESG; p<0.0001).

There were no significant differences in rates of leak, bleed, cardiac complications, pneumonia, AKI, acute renal failure, pulmonary embolism, urinary tract infections, myocardial infarctions, sepsis, venous thromboembolism, outpatient dehydration treatments, mortality or serious complications were found between procedures.

In addition, no differences were observed between procedures with regard to 30-day re-interventions or reoperations. LSG was associated with increased rates of superficial SSIs (0.25% LSG vs. 0% ESG; p=0.02) and emergency room outpatient visits (7.2% LSG vs. 4.6% ESG; p < 0.0001). Conversely, ESG was associated with increased readmission rates at 30 days (2.9% ESG vs. 2.2% LSG; p=0.02).

Multivariable logistic regression analysis revealed the following top five independent predictors of 30-day serious complications were renal insufficiency (p<0.0001), history of VTE (p<0.0001), partially dependent functional status (OR 1.84; 95% CI 1.53–2.21; p < 0.0001), prior MI (p<0.0001) and COPD (p<0.0001). The only protective factors were female sex (p<0.0001) and non-White/non-African American racial status (p<0.0001). Neither ESG nor LSG was significantly associated with serious complications after adjusting for comorbidities.

The five greatest significant contributors of emergency visits (after adjusting for comorbidities and complications) were the presence of serious complications (p<0.0001), female sex (p<0.0001), COPD (p<0.0001), Black racial status (p<0.0001) and insulin-dependent diabetes (p<0.0001). There were only two protective factors were identified, ESG (p<0.0001) and older age (p<0.0001).

The findings were featured in the paper, ‘‘Comparing Endoscopic Sleeve Gastroplasty (ESG) and Laparoscopic Sleeve Gastrectomy (LSG) 30-Day Outcomes and Healthcare Utilization: A Multi-Centered Retrospective Cohort Study of 506,597 Patients’, published in Obesity Surgery. To access this paper, please click here