65 - Outcomes of Anti-Obesity Glucagon-Like Peptide 1 Agonists vs Revisional Endoscopic Sleeve Gastroplasty for Weight Regain After Laparoscopic Sleeve Gastrectomy: A Case-Control Real World Experience

Award: Outstanding Research Award in the Obesity Category (Trainee)

Firas Bahdi, MD¹, Sagar Shah, MD², Fadi Dahoud, BSc¹, Julia L. Boland, MD², Maryam Farooq, MSEd¹, Philip Kozan, MD², Christopher Paiji, MD², Jennifer Phan, MD³, Stephen Kim, MD², Adarsh Thaker, MD², Erik Dutson, MD², Na Shen, MD¹, V. Raman Muthusamy, MD, MAS², Danny Issa, MD^2
1David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; ²UCLA, Los Angeles, CA; ³Keck School of Medicine of USC, Los Angeles, CA

Introduction: Weight regain following laparoscopic sleeve gastrectomy (LSG) is a common and challenging scenario. Minimally invasive options include anti-obesity glucagon-like peptide 1 (GLP1) agonists or revisional endoscopic sleeve gastroplasty (R-ESG). While GLP1 agonists are popular, their efficacy in LSG patients compared with R-ESG or controls with intact stomach is unclear. We share a real-world experience with GLP1 agonists & R-ESG for weight regain after LSG.

Methods: This is a retrospective study of all adult patients with a history of LSG who were treated with Sub-Q Semaglutide or Tirzepatide or underwent R-ESG for weight regain at UCLA Health from Jan 2019 till Jan 2023. A propensity-matched control group of obese patients on GLP1 agonists with no prior bariatric surgery was identified. Primary outcomes included total body weight loss (TBWL%), excess weight loss (EWL%) and adverse events (AE) on follow-up. Secondary outcomes included changes in A1c and lipid panel.

Results: The study groups included 68 (LSG+ GLP1), 20 (LSG + R-ESG), and 87 control patients. Results are presented [Table 1]. R-ESG patients were significantly younger than LSG+ GLP1 or control groups (45.2 vs 52.9 vs 51.6 yrs, P=0.03), respectively. There was no significant difference in patients baseline BMI, diabetes prevalence, %weight loss and regain after LSG, or medication dosage between groups. Difficulty with GLP1 refills was encountered in 31 LSG (45.6%) and 33 controls (37.9%). Regarding outcomes, R-ESG offered a significantly higher TBWL% than GLP1 agonists at three (10% vs 4.3%,P=0.0001) and six months (11.5% vs 6.8%,P=0.03) in LSG patients. GLP1 agonists achieved significantly lower TBWL% in LSG patients than controls at three (4.3% vs 5.7%,P=0.02), six (6.8% vs 9.2%,P=0.02), and twelve months (9.2% vs 12.7%, P=0.03). While LSG + R-ESG patients had significantly higher post-op abdominal pain than LSG+ GLP1 (10% vs 0%,P=0.04), there was no significant difference in other AE. No significant difference in the change of A1c (0.05 vs 0.6, P=0.06), LDL (-8 vs -1.1, P=0.56) or triglyceride levels (15.2 vs 27.6, P=0.59) was seen at 12 months in LSG+ R-ESG vs LSG+ GLP1, respectively.

Discussion: In a real-world experience, anti-obesity GLP1 agonists achieved significantly lower weight loss in LSG patients than those with intact stomach. R-ESG offered significantly higher weight loss than GLP1 agonists in LSG patients with weight regain while also avoiding the difficulties of GLP1 refills, making it an attractive option.



Disclosures:


Firas Bahdi, MD¹, Sagar Shah, MD², Fadi Dahoud, BSc¹, Julia L. Boland, MD², Maryam Farooq, MSEd¹, Philip Kozan, MD², Christopher Paiji, MD², Jennifer Phan, MD³, Stephen Kim, MD², Adarsh Thaker, MD², Erik Dutson, MD², Na Shen, MD¹, V. Raman Muthusamy, MD, MAS², Danny Issa, MD², 65, Outcomes of Anti-Obesity Glucagon-Like Peptide 1 Agonists vs Revisional Endoscopic Sleeve Gastroplasty for Weight Regain After Laparoscopic Sleeve Gastrectomy: A Case-Control Real World Experience, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.