Endoscopic sleeve gastroplasty versus intragastric balloon insertion as bridge-to-surgery procedures for patients with BMI ≥50 kg/m2 or contraindications to primary metabolic bariatric surgery.

BACKGROUND: Metabolic bariatric surgery is the most effective obesity treatment, but high body mass index (BMI) and associated medical problems often pose surgical risks. OBJECTIVES: This study compares the safety, feasibility, and efficacy of endoscopic sleeve gastroplasty (ESG) versus intragastric balloon (IGB) as bridge-to-surgery (BTS) procedures in patients with BMI ≥50 kg/m2 and/or contraindications to primary metabolic bariatric surgery. DESIGN: A retrospective analysis (2017 - 2024) included patients with BMI ≥50 kg/m2 undergoing ESG or IGB as a BTS procedure in a two-step approach at two German centers. METHODS: The primary outcome was total body weight loss (TBWL, %) at 6 months. Secondary outcomes included absolute weight loss, BMI reduction, excess body weight loss (EBWL, %), and adverse events between the two BTS procedures. RESULTS: Fourteen patients underwent ESG, 15 underwent IGB insertion as an intended BTS procedure. At 6 months, median %TBWL and %EBWL were significantly higher in the ESG group (17.8% (IQR, 14.5 - 22.1) vs. 8.99% (IQR, 4.6 - 14.0), p = 0.018; and 28.0% (IQR, 22.8 - 40.0) vs. 16.7% (IQR, 10.8 - 22.4), p = 0.035, respectively). IGB insertion was performed significantly faster (25 (IQR, 20.0 - 30.0) minutes (min) vs. 76 (IQR, 63.2 - 80.8) min; p < 0.01) but was associated with more mild-to-moderate adverse events (60.0% vs. 0%; p < 0.01). CONCLUSION: In this retrospective cohort, ESG was associated with greater short-term weight loss and fewer mild-to-moderate adverse events than IGB as a BTS procedure for patients with BMI ≥50 kg/m2 and/or contraindications to primary metabolic bariatric surgery (MBS).