Implementation of an Enhanced Recovery After Surgical Endoscopy protocol to improve outcomes following endoscopic...

An endoscopic sleeve gastroplasty (ESG) is a minimally invasive, transoral approach to weight loss surgery. One in 5 patients who have undergone ESG reportedly return to the emergency department (ED) within 30 days, with the majority (70%) presenting with postoperative nausea and vomiting (PONV). Implementing an Enhanced Recovery After Surgery (ERAS) protocol has been shown to reduce the incidence of PONV and lower the risk of readmission. The aim of this study was to develop and implement an ERAS protocol for adult patients undergoing ESG to prevent PONV and reduce readmissions.

An ERAS protocol for traditional bariatric surgery was adapted to create the Enhanced Recovery After Surgical Endoscopy (ERASE) protocol. ERASE was implemented in November 2021. This quality improvement project is a retrospective review of patients who underwent ESG before and after ERASE implementation from July 2019 through March 2023. Descriptive statistics and bivariate analysis were used to compare demographic data between the pre- and post-ERASE groups. Multivariable logistic regression was used to assess factors associated with postoperative outcomes.

A total of 234 patients who underwent ESG were included, with 113 in the pre-ERASE group and 121 in the post-ERASE group. There was an 86.7% compliance rate. Both cohorts presented comparable rates of PONV (P = .776). Post-ERASE implementation, there was a statistically significant reduction in postanesthesia care unit length of stay by 17.9% (P < .001) and incidence of readmission within 30 days by 58.5% (P < .05). There was a reduction by 37.8% in incidence of ED visits within 30 days in the post-ERASE group, although this was not statistically significant (P = .117).

This multidisciplinary ERASE protocol achieved a significant reduction in postanesthesia care unit length of stay and 30-day readmissions.