P1030 - Revisional Endoscopic Sleeve Gastroplasty/Endoscopic Sleeve-in-Sleeve Versus Surgical Re-Sleeve Gastrectomy in the Management of Weight Regain After Primary Sleeve Gastrectomy

Abdul-Rahman F. Diab, MD¹, Joseph A. Sujka, MD², Kathleen Mattingly, DO³, Angelica McCaskey, DO³, Abdullah Elnaji, DO³, Salvatore Docimo, DO², Christopher G. DuCoin, MD^2
1University of South Florida Morsani College of Medicine and University of Central Florida, HCA Healthcare GME, Ocala, FL; ²University of South Florida Morsani College of Medicine, Tampa, FL; ³University of Central Florida, HCA Healthcare GME, Ocala, FL

Introduction: Although sleeve gastrectomy is the most common bariatric surgery performed in the USA, weight regain is not uncommon. Surgical options for managing weight regain include re-sleeve gastrectomy (R-SG) or conversion to Roux-en-Y gastric bypass (RYGB), both of which are associated with postoperative complications. Revisional endoscopic sleeve gastroplasty (R-ESG)/endoscopic sleeve-in-sleeve (SIS) has emerged as a less invasive and potentially effective alternative. We aimed to compare R-ESG/SIS and R-SG in managing weight regain after primary sleeve gastrectomy.

Methods: We conducted a systematic literature review following PRISMA guidelines to identify articles assessing the efficacy of R-ESG/SIS, surgical re-sleeve, or both in managing weight regain after sleeve gastrectomy. Mean excess weight loss percentages (EWL%) at 1 year were collected. Analysis was conducted using a continuous random-effects model, specifically the DerSimonian-Laird method.

Results: Nine studies assessed the efficacy of either R-ESG/SIS (3 studies) or R-SG (6 studies). One study compared R-ESG/SIS directly with R-SG. For R-ESG/SIS, out of 78 patients, the pooled mean EWL% at 1 year after R-ESG/SIS (Figure 1A) was 50.687% (95% CI 31.292 – 70.082). Significant heterogeneity was observed (I² = 89.66%, p < 0.001). For R-SG, out of 310 patients, the pooled mean EWL% at 1 year (Figure 1B) after R-SG was 60.219% (95% CI 45.491 – 74.947). Significant heterogeneity was also observed (I² = 95.83%, p < 0.001). The mean difference in EWL% at 1 year between R-ESG/SIS and R-SG was -9.532 (95% CI -40.5745 – 21.5105, p = 0.5464). Thompson et al. (2020) is the single study comparing R-ESG/SIS and R-SG for managing weight regain after primary sleeve gastrectomy, showing total weight loss percentage (TWL%) after 1 year of 9.75% ± 0.92% with R-ESG/SIS versus 9.87% ± 3.86% with R-SG (p = 0.93).

Discussion: This study suggests that endoscopic revision of sleeve gastrectomy is effective in managing weight regain, with comparable efficacy to surgical re-sleeve gastrectomy. Anecdotally, surgical re-sleeve is likely associated with more adverse events; therefore, an endoscopic technique with comparable efficacy as an alternative would be valuable. However, this study has major limitations, the most important of which is that no direct comparison was done in the literature except by a single study. We call for randomized head-to-head clinical trials to reassess our findings.



Disclosures:


Abdul-Rahman F. Diab, MD¹, Joseph A. Sujka, MD², Kathleen Mattingly, DO³, Angelica McCaskey, DO³, Abdullah Elnaji, DO³, Salvatore Docimo, DO², Christopher G. DuCoin, MD². P1030 - Revisional Endoscopic Sleeve Gastroplasty/Endoscopic Sleeve-in-Sleeve Versus Surgical Re-Sleeve Gastrectomy in the Management of Weight Regain After Primary Sleeve Gastrectomy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.