PSYCHOLOGICAL AND SOCIAL FACTORS AS PREDICTORS OF PROCEDURE CHOICE BETWEEN ENDOSCOPIC AND LAPAROSCOPIC SLEEVE: A COHORT STUDY IN MATCHED CASES

Background:
Globally, availability of endoscopic weight loss procedures such as the endoscopic sleeve gastroplasty (ESG), are
increasing. Patient factors which influence choice of surgical versus endoscopic bariatric-metabolic procedure have
not been explored.

Objective:
To determine if pre-procedural weight-related psychological and social factors influence selection of ESG versus
laparoscopic sleeve gastrectomy (LSG) in matched adults.

Methods:
A prospective cohort study was conducted at a single study site in Australia offering both ESG and LSG procedures but by different proceduralists. Patients who elected an ESG were recruited and LSG patients were selected to match
for age, sex, and BMI. Weight-related psychological and social factors at baseline were measured by the Impact of Weight of Quality of Life-Lite instrument (0-100%; higher score indicated higher quality of life). Baseline body composition was measured via dual-energy x-ray absorptiometry. Means and mean ranks compared outcomes between cohorts. Adjusted binary regression was used to determine predictors procedure choice.

Results:
25 ESG and 25 LSG patients were recruited (female: 82%, mean age 41.7 [SD:9.4] years). There were no differences in comorbidities, body fat percent, nor lean mass percent (p>0.05). Both cohorts experienced severe weight-related impacts on their physical function (ESG: 57.5[SD:17.7]%; LSG: 53.3[SD:18.1]%), sexual life (ESG: 49.7[SD:28.3]%; LSG: 42.0[SD:20.5]%), public distress (ESG: 70.0[IQR:65.0-95.0]%; LSG: 67.2[SD:21.7]%), and work (ESG: 68.4[SD:19.5]%; LSG: 68.5[SD:16.3]%) (p>0.05 for all). LSG had slightly lower total weight-related
quality of life (49.5[SD:10.6]% versus 56.6[SD:12.7]%, p=0.045) but a substantially lower weight-related self-esteem (10.7 (IQR:3.6-25.0)% versus 25 (IQR:17.9-39.3)%, p=0.02), compared to ESG. For every percent increase in
weight-related self-esteem, the odds for selecting ESG increased by 4.4% (OR: 1.044; 95%CI:1.004-1.085; p=.03). Age, sex, and BMI were moderators of procedure choice in the matched cohorts.

Conclusions:
Australian adults who elected an endoscopic versus surgical sleeve may have different weight-related quality of life experiences independent of age, sex, and BMI. Reasons for these different experiences remain unexplored. Candidates with lower weight-related self-esteem may be more likely to select a surgical rather than endoscopic bariatric-metabolic procedure. Due to the low weight-related quality of life, psychological support is required for bariatric-metabolic procedure candidates regardless of procedure choice.