S1643 Redo Endoscopic Sleeve Gastroplasty: The Experience of a Tertiary Center

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Introduction: Obesity is a chronic relapsing multifactorial disease. As such, a “one and done” strategy may not lead to satisfying results in the long term for both surgical and endoscopic procedures. Endoscopic Sleeve Gastroplasty (ESG) is an effective, safe and repeatable bariatric procedure. As loss of satiety with weight regain or insufficient weight loss may occur after a primary ESG, re-ESG may play a role in such patients to improve weight loss. In this case series, we evaluate the short and medium-term outcomes of the re-ESG. Methods: A retrospective analysis was performed on a prospective database including patients who underwent ESG between March 2017 and September 2022; patients who received a re-ESG because of progressive loss of satiety, insufficient weight loss and weight regain ≥ 50% after primary ESG were included in the analysis. %EWL, %TBWL, and the Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire were assessed during follow-up. Weight loss parameters were calculated both after re-ESG and overall. Results: Of 406 patients that underwent P-ESG, 27 required a re-ESG (6.7%) after a mean time of 20 months (range 7-42). Re-ESG was technically feasible in all patients and no periprocedural adverse events occurred. The mean BMI was 38.4 ± 6.5 kg/m2 and 35.5 ± 6.0 kg/m2 at P-ESG and re-ESG, respectively. Weight loss and quality of life (QoL) outcomes are summarized in All patients reported a proper sense of satiety and substantial improvement in quality of life after the re-ESG. Conclusion: According to our experience, re-ESG has satisfying short and medium-term outcomes in terms of satiety, weight loss and quality of life. As such, repeating ESG should not be seen as a failure, but a further step in the endoscopic approach to obesity (Table 1). Table 1. - Weight loss and quality of life outcomes after re-ESG 1 month 3 months 6 months (n= 12 months (n=11) Overall %TBWL 15.2% ± 8.0 19.0% ± 8 18.2% ± 8.1 18.7% ± 6.2 Re-ESG %TBWL 10.3% ± 6 13.2% ± 6.4 13.6% ± 7.7 14.1% ± 7.5 Overall %EWL 47.1% ± 21.3 57.1% ± 21.9 53.8% ± 21.9 55.5% ± 18.5 Re-ESG %EWL 38.0% ± 17.2 47.4% ± 21.7 46.2% ± 22.1 47.8% ± 24.9 BAROS score 3.6 ± 1.5 4.2 ± 1.6 4.2 ± 2.0 4.1 ± 1.8 Values are mean ± standard deviation.

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