CHARLOTTE, N.C.—Most of the research on endoscopic sleeve gastrectomy has been conducted in people with a body mass index of 30 to 40 kg/m². But the short-term results of a new study suggest the endoscopic alternative to bariatric surgery might be equally equally safe and as effective in heavier patients—a promising finding considering the patients who are most likely to seek bariatric surgery have a BMI greater than 40 kg/m².

“Our study was one of the very few, and the largest to date, to investigate how endoscopic sleeve gastrectomy [ESG] does in BMI over 40,” said lead researcher Anuragh Gudur, MD, a resident at the University of Virginia, in Charlottesville, who presented the study at the 2022 annual meeting of the American College of Gastroenterology (abstract C0451).

In a retrospective, propensity-matched review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, Dr. Gudur and his colleagues first stratified ESG patients into two categories: those with BMIs of 30 to 40 kg/m² (class I and II) and those with BMIs 40 kg/m² and higher (class III), with 2,626 patients in each group.

“We didn’t find any difference in adverse events, readmissions or reinterventions between the two BMI groups,” Dr. Gudur told Gastroenterology & Endoscopy News. Patients in the lower BMI class had a weight loss of about 1.35 kg at 30 days, compared with 2.25 kg in the class III obesity patients.

They then evaluated only those patients with a BMI of 40 kg/m²: 2,626 who underwent ESG; 5,252 who underwent sleeve gastrectomy; and 5,252 who underwent Roux-en-Y gastric bypass (RNYGB).

“When comparing ESG to bariatric surgery modalities, we noticed that ESG had a comparable rate of adverse events compared with sleeve gastrectomy, and far fewer than RNYGB,” Dr. Gudur said.

The percentage of body weight loss at 30 days was similar among the three procedure types: about 2.25 kg.

“Overall, what we want people to take away from this study is that we feel that ESG can be safe in patients with a BMI greater than 40,” Dr. Gudur said.

However, acknowledging that the “weight loss results are very short term” she said, “I think we need further studies looking at only patients with BMI greater than 40, “and I think we can carve out a new niche for those patients and expand who qualifies for ESG, regardless of their BMI class.”

—Monica J. Smith

Dr. Gudur reported no relevant financial disclosures.