TOPLINE

Endoscopic sleeve gastroplasty (ESG) performed in an ambulatory setting appeared to be feasible and safe in selected patients with obesity, with only 4% requiring unplanned hospitalization. No major complications or deaths were reported.

METHODOLOGY

• Although ESG is gaining popularity as a minimally invasive treatment for obesity, the optimal setting (ambulatory or inpatient) and which patients may require hospitalization remain under discussion.
• Researchers reported a case series of patients who underwent ESG to compare the demographic and clinical characteristics of those managed in an ambulatory setting with those who required hospitalization and to evaluate the safety and feasibility of ESG in an outpatient setting.
• The analysis included 430 consecutive patients (median age, 43 years; 77.4% women; median BMI, 38.67) who underwent ESG at a hospital in France between November 2016 and April 2025; 228 procedures (53%) were performed in an ambulatory setting with same-day discharge, and 202 (47%) required hospitalization. The median operative time was 29 minutes.
• All procedures were initially performed under general anesthesia, but as experience increased, deep sedation was progressively adopted for selected patients on the basis of body weight and comorbidities to maintain adequate safety standards.
• The primary outcome was the need for hospitalization after ESG; secondary outcomes were differences in periprocedural characteristics and unplanned postoperative admissions.

TAKEAWAY

• Patients managed in an ambulatory setting were younger, had a lower median BMI, and had lower rates of diabetes and obstructive sleep apnea syndrome than those who required hospitalization (P < .001 for all).
• Only 4% of patients treated in the ambulatory setting required unplanned hospitalization after ESG, primarily because of nausea and pain, and all were discharged within 24 hours.
• In a multivariable analysis, the use of sedation was independently associated with ambulatory management (P < .05 for all), suggesting that sedation may support outpatient management when applied appropriately.
• No major complications or deaths occurred among patients managed in an ambulatory setting.

IN PRACTICE

“Overall, our findings suggest that ESG can be safely integrated into ambulatory care models when performed in carefully selected patients within structured periprocedural pathways and by experienced multidisciplinary teams,” the authors of the study wrote.

“The adoption of ambulatory management may contribute to more efficient use of healthcare resources and improved procedural throughput without compromising patient outcomes,” they added.

SOURCE

The study was led by Elisa Reitano, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. It was published online in Obesity Surgery.

LIMITATIONS

The study was conducted retrospectively at a single center. Clinical practice evolved during the study period from routine hospitalization to ambulatory management with deep sedation, which may have influenced the results. Differences in patient selection and institutional experience may have limited the applicability of the findings to other centers.

DISCLOSURES

The study did not receive any funding. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.