Secular trends of endoscopic sleeve gastroplasty: analysis of the MBSAQIP database

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoluminal procedure for the management of obesity and has become increasingly popular in patients who are poor surgical candidates or who choose against surgical intervention. This study aims to evaluate secular trends of ESG in a large bariatric procedure-specific clinical database.

We analyzed patients who underwent ESG from 2020 to 2023 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Annual incidence, patient characteristics and trends in 30-day serious adverse events following ESG were collected.

A total of 2371 patients (mean age 45y, 85.8% F, mean BMI 40 kg/m²) underwent ESG between 2020 and 2023. The number of ESGs increased by 50.5% across the study period. ESG volume increased significantly over time (IRR 1.11 per year, 95% CI 1.07-1.15; p < 0.01). Mean BMI increased 7.9% across the study period, rising from 37.8 kg/m² to 40.8 kg/m², respectively (p < 0.01) (Fig. 1B). Despite the rise in BMI and other pre-procedural comorbidities, there was no statistically significant difference in the incidence of adverse events across the study period.

The number of ESGs being performed has significantly increased over the past few years. Despite expanding ESG to a higher-risk patient population, the incidence of serious adverse events following ESG has remained extremely low with no significant increase over the study period. As endoscopic techniques continue to evolve, ESG acts as a model for the future of endoluminal therapies in high-risk patient populations.