Operator-specific outcomes in endoscopic sleeve gastroplasty: a propensity-matched analysis of the US population using a multicenter database.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) has emerged as an effective endoscopic bariatric procedure over the past decade. Data comparing short-term outcomes of ESG based on operator specialty is scarce. We aimed to assess the impact of operator specialization on patient outcomes using a large bariatric-specific database.

METHODS: We identified a retrospective cohort of patients who underwent ESG by gastroenterologists using the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database (2020-2021). A matched comparison cohort of patients who underwent ESG by surgeons was identified and underwent 1:1 propensity score matching based on age, race, gender, American Society of Anesthesiologists physical status classification, and preoperative body mass index.

RESULTS: After matching, 154 patients were included in the final analysis. Of these, 77 patients underwent ESG by surgeons and 77 by gastroenterologists. In the matched cohort, the median operation time was lower in ESG by surgeons compared to gastroenterologists ( P  < 0.001). The median percent body mass index decrease was higher in the gastroenterologist cohort compared to the surgeon cohort (4.9% vs 3.8%, P  = 0.04). The median percent weight loss after ESG was 4.8% in the surgeon cohort and 5.9% in the gastroenterologist cohort ( P  = 0.09). There was no statistically significant difference in postoperative emergency department visits ( P  = 0.65), reoperations ( P  = 0.15), or reinterventions within 30 days ( P  = 0.87) between the cohorts. There was no difference in major adverse effects between the groups (0% each).

CONCLUSIONS: Operator choice does not affect ESG-related adverse events or 30-day outcomes in patients undergoing ESG.