Outcomes of Endoscopic Sleeve Gastroplasty Following Laparoscopic Adjustable Gastric Band: A Propensity Score-matched Analysis

Background:The performance of endoscopic sleeve gastroplasty (ESG) in patients with prior laparoscopic adjustable gastric band (LAGB) has not been characterized.Materials and Methods:This is a retrospective propensity score-matched study of ESG after LAGB at 2 centers with expertise in bariatric endoscopy. The primary outcome was total weight loss (TWL) at 12 months. Secondary outcomes included TWL at 3 and 6 months, 12-month excess weight loss (EWL), procedural characteristics, predictors of TWL, and serious adverse events.Results:Twenty-six adults (88.5% female, age 50.8 y, BMI 36.5 kg/m2) with prior LAGB (median duration 8 y) underwent ESG at a median of 3 years after LAGB removal. A 2:1 age-matched, sex-matched, and BMI-matched comparator group was created, comprising ESG patients from the same organization and time frame but without prior LAGB. TWL for the LAGB-to-ESG cohort versus the ESG-only cohort was 10.1 +/- 5.5% versus 13.0 +/- 4.4% at 3 months (P=0.0256), 12.4 +/- 7.2% versus 16.0 +/- 5.4% at 6 months (P=0.0375), and 12.7 +/- 8.2% versus 18.4 +/- 6.5% at 12 months (P=0.0149). At 12 months, the LAGB-to-ESG cohort had an EWL of 52.5 +/- 50.0%, and 75% achieved TWL >= 10%. There was no association between TWL at 3, 6, or 12 months and the following traits: age or BMI at the time of ESG, patient sex, and time from LAGB removal to ESG. No serious adverse events occurred in either cohort.Conclusion:ESG after LAGB facilitates safe and clinically meaningful weight loss but is attenuated compared to primary ESG.