Endoscopic sleeve gastroplasty (ESG) was safe and similarly effective as sleeve gastrectomy (SG) or Roux-en-Y bypass (RNYB) among patients with class III obesity, according to study results presented at the American College of Gastroenterology (ACG) 2022 Annual Meeting, held from October 21 to 26, 2022, in Charlotte, North Carolina, and virtually.

Few patients (<1%) eligible for gastric bypass undergo the procedure, primarily due to fears of adverse events. An ESG approach has the potential to increase patient uptake of weight loss interventions. However, there remains a paucity of data about safety and efficacy of ESG among patients with class III obesity (BMI >40kg/m2).

To better understand ESG outcomes in the setting of class III obesity, investigators from the University of Virginia sourced data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, which collected patient data from 800 hospitals between 2016 and 2020. Safety and efficacy of ESG in class III was compared with classes II (BMI 35-40kg/m2) and I (BMI 30-35kg/m2) obesity and with SG and RNYB. A propensity matching approach was used to balance for cohort differences.

In the ESG comparison between class III obesity (n=2626) and classes II and I obesity (n=2626), class III obesity was assoicated with longer procedure times (mean, 68.94 vs 60.49 min; P <.001) and postoperative hospital stays (mean, 1.01 vs 0.73 days; P <.001) compared with the class II/I group, respectively.

The class III group had a greater change in postoperative BMI (mean, -2.44 vs -1.30kg/m2P <.001) and total body weight loss at 30 days (mean, 5.0% vs 3.2%; P <.001) compared with classes II/I, respectively.

No significant difference in any safety signals were observed on the basis of obesity class, except that the class III group had a higher rate of emergency department visits not resulting in admission (5.6%) compared with the class II/I group (4.1%; P =.012).

In the comparison of ESG with SG (n=5252) and RNYB (n=5252) among patients with class III obesity, ESG was associated with shorter procedure times (mean, 68.94 vs 78.99 vs 134.97 min) and postoperative hospital stays (mean, 1.01 vs 1.52 vs 1.94 days) compared with SG and RNYB (all P <.001), respectively.

ESG was assoicated with a smaller change in postoperative BMI (mean, -2.44kg/m2) compared with SG (mean, -2.65kg/m2P =.002), but not RNYB (mean, -2.58kg/m2P =.057). ESG associated with lower total body weight loss at 30 days (mean, 5.0%) compared with both SG (mean, 5.4%; P <.001) and RNYB (mean, 5.3%; P =.003).

The safety profile of ESG was superior to SG with regard to vein thrombosis events and superior to RNYB with regard to major adverse events, pneumonia, blood transfusions, unplanned intensive care unit admissions, reoperations or readmissions within 30 days, outpatient treatment for dehydration, and emergency department visits not resulting in admission.

The study authors concluded that ESG is safe for patients with class III obesity and its efficacy was comparable to SG and RNYB.

“Clinicians should consider expanding access to ESG regardless of BMI,” the study authors wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.


Gudur A, Geng C, Radlinski M, et al. Endoscopic sleeve gastroplasty in class III obesity (BMI>40): a propensity-matched, retrospective comparison of short-term safety and efficacy vs bariatric surgery. Abstract presented at: ACG 2022 Annual Meeting; October 21 to 26, 2022; Charlotte, NC. Abstract C0451.

This article originally appeared on Gastroenterology Advisor.