P4840 - Minimally Invasive Solutions for Obesity: A Real-World Comparison of Endoscopic and Laparoscopic Sleeve Procedures

Ali Osman, MD, MSCI Candidate¹, Ahmed Dirweesh, MD², Stuart K. Amateau, MD, PhD²
1Washington University School of Medicine in St. Louis, Ballwin, MO; 2University of Minnesota Medical Center, Minneapolis, MN

Introduction: Endoscopic Sleeve Gastroplasty (ESG) and Laparoscopic Sleeve Gastrectomy (LSG) are both established interventions for the treatment of morbid obesity. While LSG remains more commonly performed, ESG has gained attention as a minimally invasive alternative. However, comparative real-world data on their safety and metabolic outcomes are limited.

Objective:
To compare the safety and metabolic efficacy of ESG and LSG using a propensity score–matched real-world cohort derived from a federated electronic health record database.

Methods: Adults (≥18 years) with morbid obesity (ICD-10: E66.01) who underwent ESG (HCPCS: C9784) or LSG (CPT: 43775) were identified from the TriNetX Global Collaborative Network. A 1:1 propensity score–matched analysis was conducted based on age, sex, race, and comorbidities. The primary safety endpoint was a composite of gastrointestinal bleeding, gastric ulcer with hemorrhage, perforation, postoperative infection, severe malnutrition, and vomiting. Metabolic efficacy outcomes included 1-year changes in BMI, weight, HbA1c, lipids, and blood pressure. Statistical analyses included risk differences, Kaplan-Meier survival analysis, and comparisons of mean changes in laboratory and vital sign parameters.

Results: After matching, 62 patients were included in each group. ESG was associated with a significantly lower incidence of the composite safety outcome compared to LSG (0% vs. < 17.2%, p = 0.001). However, due to TriNetX’s data obfuscation policy, the exact number of events in the LSG group is not disclosed when fewer than 10 events are present; thus, the reported 17.2% represents an upper-bound estimate

Event-free survival did not differ significantly between groups (p = 0.36). Both ESG and LSG led to meaningful improvements in BMI, HbA1c, and blood pressure. ESG showed greater reductions in total cholesterol (−7.1% vs. −2.2%) and LDL (−12.2% vs. −1.9%), while LSG resulted in more pronounced reductions in total body weight (−21.3% vs. −14.8%) and triglycerides (−24.8% vs. +9.9%)

Discussion: In this matched real-world cohort, ESG demonstrated superior short-term safety and comparable metabolic improvements to LSG, with distinct effects on lipid profiles. ESG may represent a safer, less invasive alternative to LSG for appropriately selected patients with morbid obesity.


Figure: Table 1. Baseline characteristics of ESG and LSG groups before and after matching.


Figure: Fig-1 Comparison of Metabolic parameters Before and After ESG/LSG.

Disclosures:
Ali Osman indicated no relevant financial relationships.
Ahmed Dirweesh indicated no relevant financial relationships.
Stuart Amateau: BSC – Consultant. Cook – Consultant. Endo-Therapeutics – Consultant. Merit – Consultant. Olympus – Advisor or Review Panel Member, Consultant. Provation – Advisory Committee/Board Member. Steris – Consultant.

Ali Osman, MD, MSCI Candidate¹, Ahmed Dirweesh, MD², Stuart K. Amateau, MD, PhD². P4840 - Minimally Invasive Solutions for Obesity: A Real-World Comparison of Endoscopic and Laparoscopic Sleeve Procedures, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.