First Case Series on Ambulatorial Endoscopic Sleeve Gastroplasty for Morbidity Obesity: A Single Center Experience

Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive endoscopic weight-loss procedure. Its outpatient application can reduce hospital stays and speed up recovery. The aim of this study is to compare ambulatory and hospitalized patients, identify predictors of hospitalization, and assess the safety and feasibility of outpatient ESG.

From November 2016 to April 2025, we performed 430 ESG procedures, with 228 (53%) completed in an ambulatory setting and 202 (47%) requiring hospitalization. We retrospectively analysed demographic and procedural data. Continuous variables were compared by independent sample Kruskal-Wallis test, while categorical variables were analysed using Pearson's chi-squared test. Logistic regression model was used to identify predictors of hospitalization.

The cohort included 97 males (22.7%) and 333 females (77.4%), with a mean age of 43 years [IQR 33-52], mean weight of 108 kg [IQR 95-123], and a mean BMI of 38.67 [IQR 35.57-42.99]. The mean operative time was 29 min [IQR 24-37]. Comparative analyses between ambulatory and hospitalized patients are summarized in Table 1, identifying age, BMI, general anaesthesia, and ASA class as predictors of hospitalization. Among the 228 ambulatory patients, 9 (4%) required unplanned postoperative admission. These patients demonstrated lower Chung scores at reassessment, primarily due to nausea and pain. No differences were observed in preoperative variables.

Ambulatory ESG is a safe, effective, and efficient option for selected patients, with a low rate of post-procedure hospitalization, representing a promising approach in bariatric endoscopy.