Early Safety of Endoscopic Sleeve Gastroplasty in Super Obesity (BMI > 50)

Background The prevalence of super obesity (BMI > 50) continues to rise. However, the adoption of bariatric surgery in this population remains very low. There are limited studies evaluating the utility of endoscopic sleeve gastroplasty (ESG) in super obesity. Objectives The purpose of this study is to evaluate the short-term safety profile of ESG in patients with super obesity using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Setting United States Methods We retrospectively analyzed patients who underwent ESG and sleeve gastrectomy (SG) from 2016-2021. Patients with BMI>50 who underwent ESG were compared to ESG patients with BMI<50 and also SG patients with BMI>50. Primary outcomes included the incidence of severe adverse events (AE), hospital readmission, reintervention, and reoperation within 30 days of the primary procedure. Secondary outcomes included procedure time, hospital length of stay (LOS), and total body weight loss (TBWL) at 30 days. Results There were no significant differences in AE, reoperations, hospital readmissions, or reinterventions for patients with super obesity undergoing ESG, compared to patients with BMI below 50. Mean TBWL was greater in patients with super obesity. There were no significant differences in AEs for patients with super obesity who underwent ESG vs SG, although ESG patients had more hospital readmissions, reinterventions, and reoperations. Conclusion ESG may be performed safely, with comparable safety to SG, in patients with BMI as high as 70. However, further studies are needed to validate the feasibility and long-term efficacy prior to clinical implementation.