S780 Predictors of Weight Loss Following Endoscopic Re-Suturing Post Endoscopic Sleeve Gastroplasty

Introduction: Endoscopic sleeve gastroplasty (ESG) is an effective and durable means for obesity treatment by reducing gastric body volume and impairing gastric emptying. However, a subset of patients experience weight regain or have a plateau in weight loss. The best management strategies for these patients remains unclear. Redo-ESG (R-ESG) is an option to treat weight regain and has been shown to be superior to anti-obesity medications (AOM) alone. While factors associated with weight loss following ESG have been established, predictors of weight loss following R-ESG have not been well studied. Methods: We performed a retrospective analysis of a prospective database including data on all R-ESG procedures performed from January 2013 to May 2024. Inclusion required patients be at least 18 years of age with 2-year follow up data following primary-ESG (P-ESG) and 1-year follow up after R-ESG. Baseline demographic data, medical history, surgical history, procedure factors, medication use, and weight parameters were extracted through chart review. Our primary outcome was factors associated with total body weight loss (TBWL) 6 months following R-ESG. Results: A total of 53 patients were included with a median age of 42 (interquartile range [IQR] 32-52), of which 70% were women. The mean time between P-ESG and R-ESG was 963 days (SD 597.21). 53% of patients were administered a glucagon-like peptide 1 receptor agonist (GLP-1RA) following R-ESG. On univariable regression, greater TBWL at 6 months post-P-ESG and higher body mass index (BMI) prior to P-ESG and R-ESG were associated with greater TBWL at 6 months following R-ESG on univariate analysis. Additionally, TBWL at 1 month following R-ESG was associated with TBWL at 6 months following R-ESG. These variables remained significantly associated with TBWL at 6 months following R-ESG after adjusting for age, sex, BMI, number of sutures used during R-ESG, and use of GLP-1RA and other AOM following R-ESG. Clinically significant TBWL, defined as TBWL >10%, at 6 months following R-ESG was associated TBWL at 6 months following P-ESG on multivariable logistic regression after adjusting for these same covariates. Conclusion: This study identifies factors associated with TBWL following R-ESG. Greater TBWL following P-ESG and early weight loss following R-ESG was associated with 6-month weight loss following R-ESG. These findings mirror predictors of weight loss following P-ESG. This study may help identify patients who will respond to revisional therapy.