S2311 Transforming Cardiovascular Risk Through Endoscopic Sleeve Gastroplasty: 1-Year Outcomes in a Real-World Population

Introduction: Endoscopic sleeve gastroplasty (ESG) is a novel, minimally invasive endoscopic bariatric procedure that induces significant weight loss and metabolic improvement by reducing gastric volume and delaying gastric emptying. While ESG has shown promise in prospective clinical trials, its impact on long-term cardiovascular risk, particularly atherosclerotic cardiovascular disease (ASCVD) risk has not been well characterized in real-world populations. This study evaluates 1-year changes in weight, lipid profiles, blood pressure, and both 10-year and lifetime ASCVD risk following ESG in a real-world cohort at a tertiary academic center. Methods: We conducted a retrospective cohort study of adult patients with obesity who underwent ESG between 2013 and 2022. Inclusion criteria were age ≥18 years, available pre-procedure and 1-year follow-up data, and absence of prior metabolic or bariatric surgery. Clinical parameters were collected including age, sex, race, weight, height, BMI, blood pressure, and lipid profiles. The primary outcomes were changes in 10-year and lifetime ASCVD risk scores, calculated using the ACC/AHA pooled cohort equations. Secondary outcomes included total body weight loss percentage (TBWL%) and changes in systolic and diastolic blood pressure, total cholesterol, LDL-C, and HDL-C. Matched paired t-tests were used for comparisons of pre- and post-ESG values. Results: Out of 183 patients, a total of 33 patients with pre- and post-ESG data were included in the analysis (mean age 49.6 ± 11.1 years; 84.9% woman; 93.9% White). At 1-year post-ESG, 10-year ASCVD risk dropped from 1.8% to 1.1% (mean change −0.7%, P < 0.01), while lifetime ASCVD risk decreased from 37.3% to 32.9% (mean change −4.4%, P = 0.09). Patients experienced significant TBWL% (−12.9 ± 2.2%, P < 0.01). Lipid changes were not statistically significant: LDL-C (−2.3 mg/dL, P = 0.58), total cholesterol (−6.3 mg/dL, P = 0.19), and HDL-C (+2.7 mg/dL, P = 0.07). Systolic blood pressure declined by −6.9 mmHg (P = 0.006), while changes in diastolic pressure were modest and non-significant (−1.9 mmHg, P = 0.36). Conclusion: In this clinical cohort, ESG was associated with significant weight loss and clinically meaningful improvements in 10-year ASCVD risk. Further prospective and comparative studies with larger cohort size are warranted to validate these findings.