Venous thromboembolism after endoscopic sleeve gastroplasty

Anticoagulation is frequently prescribed for prophylaxis of venous thromboembolic events (VTEs) such as deep vein thrombosis (DVT) or pulmonary embolism (PE) after bariatric surgery. Currently, there are no established guidelines on periprocedural management of VTEs after endoscopic sleeve gastroplasty (ESG), a less invasive treatment option for obesity. This study aims to determine the incidence of DVT and PE within 30 days after ESG and evaluate current practice patterns of periprocedural VTE prophylaxis.

Patients who underwent ESG from 2020 to 2023 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were analyzed. Data on preoperative incidence of DVT, therapeutic anticoagulation, venous stasis, and VTE prophylaxis methods were collected. The primary outcome was the frequency of post-ESG DVT and PE at 30 days. Secondary outcomes were the methods of VTE prophylaxis and the comorbid predictors of VTEs from ESG.

A total of 2371 ESG patients (mean age, 45 years; 85.8% female; mean body mass index, 40) were included in this study. Before ESG, 29 (1.2%) had a history of DVT and 38 (1.6%) were on therapeutic anticoagulation. A total of 1106 (46.7%), 16 (0.7%), 295 (12.4%), and 954 (40.2%) patients were on mechanical only, pharmacologic only, both mechanical and pharmacologic, and no VTE prophylaxis, respectively. The 30-day incidence of postoperative DVT and PE was 7 (0.3%) and 5 (0.2%), respectively. Two-thirds of patients who developed VTEs were not on prophylaxis before ESG.

The incidence of VTEs after ESG is extremely low in this large prospective multicenter database. Although events occurred in fewer than 0.5% of cases, a majority of patients who developed DVT or PE after ESG did not receive pharmacologic or mechanical prophylaxis. Decisions surrounding the selection of VTE prophylaxis should be made based on patient comorbidities, with consideration for low-risk interventions such as mechanical prophylaxis in all patients undergoing ESG.