Endoluminal procedures for bariatric patients: expectations among bariatric surgeons

Primary and revisional bariatric endoluminal procedures are currently being developed. Acceptable levels of risk and weight loss for these procedures have not yet been established. The aim of this study was to evaluate the expectations and concerns among bariatric surgeons regarding these procedures.

The American Society for Metabolic and Bariatric Surgery Emerging Technologies Committee developed a questionnaire that was distributed to the membership. Risk tolerance was assessed with comparison to commonly performed endoscopic and bariatric procedures. The percentage of excess weight loss (EWL) ranges were provided to assess the expectations for results 1 year after the procedure.

A total of 214 responses were returned. The acceptable level of risk to achieve 10-20% EWL after primary and revisional procedures was equivalent to, or less than, that of a therapeutic endoscopic procedure for 81% and 76% of respondents, respectively. The acceptable level of risk to achieve 30-40% EWL after primary and revisional procedures was equivalent to that after laparoscopic adjustable gastric banding for 45% and 35% of respondents, respectively and equivalent to that after laparoscopic Roux-en-Y gastric bypass for 8% and 22%, respectively. In addition, 62% of respondents responded that 10-30% EWL would be acceptable for revisional procedures, and 35% responded that 10-30% EWL would be acceptable after a primary procedure. The primary concern was unproven efficacy, followed by durability, poor weight loss, availability of equipment, and procedural risk. Finally, 58% would not be willing to recommend an endoluminal procedure until the efficacy has been established, regardless of the risk.

Risk tolerance and weight loss expectations among bariatric surgeons are different for primary and revisional endoscopic procedures. Most surgeons were unwilling to consider endoluminal procedures for their patients until the efficacy has been proven.