Multimodal Antiemetic Prophylaxis in Patients Undergoing Endoscopic Sleeve Gastroplasty: A Single-Center...

Endoscopic sleeve gastroplasty (ESG) is associated with a high incidence of postoperative nausea and vomiting (PONV) due to gastric volume reduction, preservation of vagal innervation, and inherent patient-related risk factors. Standard antiemetic prophylactic regimens are frequently insufficient in this population. This case series describes the clinical experience and postoperative outcomes associated with a multimodal antiemetic prophylaxis regimen.

In this single-center retrospective case series, data from 20 adult patients who underwent ESG under general anesthesia were analyzed. Anesthesia maintenance was standardized using manually controlled intravenous infusions of propofol and remifentanil (TIVA), without volatile anesthetics. Multimodal antiemetic prophylaxis consisted of intravenous granisetron (3 mg), dexamethasone (8 mg), haloperidol (1 mg at induction + 1 mg before emergence), and fosaprepitant (150 mg). Postoperative analgesia was managed primarily with paracetamol and ibuprofen. The primary outcome was clinically documented PONV during the early postoperative period, including the PACU stay and the first 12 postoperative hours. Emergency department presentations for severe PONV within 5 postoperative days were assessed as a secondary outcome using institutional electronic health records.

The cohort comprised 20 patients (70% female, mean age 41.05 ± 11.22 years, mean BMI 38.33 ± 4.94 kg/m²). Comorbidities were present in 55% of patients, and 80% were non-smokers. During the early postoperative period, no clinically documented episodes of PONV requiring rescue antiemetic treatment were identified.

In this small retrospective case series, multimodal antiemetic prophylaxis combined with TIVA was associated with no institutionally documented early postoperative PONV presentations and emergency department presentations for severe PONV within 5 days after ESG. Prospective studies with standardized postoperative PONV assessment are needed to determine the efficacy of this approach. Given the limitations of a retrospective case series, prospective controlled trials incorporating systematic PONV severity scoring are warranted to establish optimized guidelines.