EFFICACYOF ENDOSCOPIC RESUTURING VERSUS PHARMACOTHERAPY TO TREAT WEIGHT RECIDIVISM AFTER ENDOSCOPIC SLEEVE GASTROPLASTY.

BACKGROUND AND AIMS: A subset of patients experience weight recidivism after primary endoscopic sleeve gastroplasty (P-ESG). Available options for management of weight regain include initiation of anti-obesity medications (AOM) or redo ESG (R-ESG). The comparative effectiveness of these options is not clear.

METHODS: This is a retrospective analysis of a prospectively maintained database of patients undergoing ESG. From 2013 to 2021, 79 patients who were started on AOM, or underwent R-ESG for management of weight recidivisim after P-ESG were included. The primary outcome of this study was final total body weight loss (TBWL) at the end of follow up.

RESULTS: Fifty five patients were started on AOM and 24 patients underwent R-ESG. The age, gender distribution and baseline BMI did not differ significantly between groups. The proportion of non-compliant patients (defined as patients who missed their first post ESG follow up visit) was significantly higher in the AOM group compared with R-ESG group (67% versus 35%, p=0.012). The additional TBWL after R-ESG was significantly (both clinically and statistically) better than after initiation of AOM (9.5±7.2% versus 2.1±8.6%, p=0.001). Final TBWL clearly favored R-ESG over AOM for treatment of weight recidivism (19.9±10.4% versus 13.6±9.2%, p=0.028).

CONCLUSIONS: R-ESG is an effective treatment to induce weight loss after experiencing weight recidivism. These results highlight an important advantage of ESG as a repeatable minimally-invasive procedure.