Comparison of endoscopic sleeve gastroplasty versus surgical sleeve gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database analysis

Post written by Anuragh R. Gudur, MD, from the Division of Gastroenterology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.


Our study used a large, multicentered, bariatric-specific data registry to analyze short-term outcomes after endoscopic sleeve gastroplasty (ESG) in comparison with surgical sleeve gastrectomy (SG). We also sought to examine which factors were associated with adverse events (AEs) after ESG, with a particular interest on the impact of race.

With ESG being used more widely, we felt it was important to examine large-scale trends of the procedure, particularly in terms of safety profile. Most studies with respect to ESG have been limited to smaller patient cohorts.

We primarily compared short-term post-ESG AEs, readmissions, reinterventions, and reoperations in comparison with that of SG. We also wanted to explore whether race impacted the occurrence of AEs after ESG, as prior studies have established that certain races are predisposed to greater AEs after traditional bariatric surgery.

Our study represents one of the largest analyses of ESG to date. We found a similarly low rate of AEs between ESG (1.4%) and SG (1.1%), which is consistent with other reports. A distinctive finding in our study is that patients who underwent ESG had more readmissions, reinterventions, and reoperations within 30 days than SG patients.

In addition, we noted that race was not associated with AEs after ESG, whereas black race was associated with a higher risk of AEs after SG.

It is important to acknowledge the limitations associated with large-scale databases such as lack of granularity and inability to capture the procedural experience of the centers that performed ESG.

However, it is encouraging that our study confirms the early safety of ESG compared with SG in a very large, generalizable study population. To that point, the results of the recent Multi-center ESG Randomized Interventional Trial (MERIT-Trial) demonstrated a similar AE profile.  

In the future, we hope that collaborative studies among multiple centers will maintain large data repositories to help analyze trends of the use of ESG and long-term outcomes at a larger scale. We are excited to witness the growth of ESG as an adjunct to bariatric surgery.

Gudur_figureFactors impacting AEs after ESG.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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