A NATIONAL SURVEY ON THE RISING ROLE OF ENDOSCOPIC BARIATRIC PROCEDURES FOR THE MANAGEMENT OF NONALCOHOLIC STEATOHEPATITIS

Document Type

Conference Proceeding

Publication Date

11-14-2023

Publication Title

Hepatology

Abstract

Background: Weigh loss is the cornerstone of halting disease progression in patients with nonalcoholic fatty liver disease (NAFLD) and preventing nonalcoholic steatohepatitis (NASH). Patients who fail to lose weight through conservative modalities are often offered the option of bariatric surgeries, but most patients are either high-risk surgical candidates or prefer non-surgical modalities. Endoscopic Sleeve Gastrectomy (ESG) was introduced as a minimally invasive bariatric procedure that provides patients with acceptable weight loss and improvement in their metabolic disease that contributes to NAFLD and NASH. In the study, we aimed to conduct a national survey to evaluate practicing gastroenterologist's perception on the role of ESG for managing NASH. Methods: We conducted a descriptive study through a national survey of 15 questions. The survey was built through an online cloud-based software, and a link was emailed to a total of 493 U.S. GI fellowship programs. The email recipients were asked to forward the survey link to additional faculty members. There was no monetary compensation for filling out the survey. The survey was anonymous, and no physician or patient identifier was shared. Total estimated time for completing the survey was 4 minutes. Results: A total of 54 responses were obtained during the time period 01-09-2021 and 2-12-2021, with estimated completion rate of 50%. Survey questions were summarized in Table 1. The majority of participants, 72%, were from tertiary care academic center, mostly commonly located in the Midwest, (39%). About half (48%) of the institutions had an established multidisciplinary team to manage patients with NASH who failed to lose weight following conservative modalities, with 65% having an advanced endoscopist trained in bariatric endoscopy in the team. Providers were most commonly, advanced endoscopists (40%), hepatologists (26%), general gastroenterologists, (18%), and gastroenterology fellows (11%). More than half of the participants (62%) encountered NASH patients sometimes with BMI > 40 kg/m2 who failed the current standard of care noninvasive weight loss measures, and refused surgical bariatric procedures, or deemed not to be a surgical candidate. Providers reported that endoscopic bariatric options, most commonly ESG (80%), are sometimes discussed with the patients in 46% of the times. Barriers for referral for endoscopic bariatric procedures in NASH patients were overwhelmingly due to lack of insurance coverage in 86% of the times while 32% of the participants thought that there was still not enough literature. Advanced endoscopists reported that they are unable to obtain insurance coverage for managing NASH patients in 78% of the time. Conclusion: NASH is projected to be the leading cause of cirrhosis, and the utilization of novel management modalities such as ESG are overwhelmingly impacted by the health insurance reimbursement policies.

Volume

78

First Page

S1230

Last Page

S1231

Find It @ Sladen

Share

COinS