Comparable Short-Term Weight Loss and Safety of Endoscopic Sleeve Gastroplasty in Diabetic and Non-diabetic Patients

BACKGROUND

Endoscopic sleeve gastroplasty (ESG) is a highly effective endo bariatric procedure. Data on outcomes of ESG in patients with diabetes mellitus (DM) compared to non-diabetics are limited.

AIMS

We aim to assess differences in clinical outcomes of ESG in DM patients in North America.

METHODS

We used the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database from 2016 to 2021 to identify all DM patients who underwent ESG as the primary procedure for weight loss. A 1:1 propensity score matched cohort of non-DM patients served as controls. Patient characteristics, clinical outcomes, and complications were compared and analyzed. Adult patients with Class I obesity and above were included.

RESULTS

After matching, 310 DM and non-DM patients that underwent ESG were compared. The median % BMI decrease (3.3% vs. 3.1%, P = 0.62) and median total body weight loss (%TBWL) (4.3% vs. 4%, P = 0.75) in 30 days were similar in the DM compared to non-DM cohorts. A similar proportion of patients with major adverse events (AEs) were present after ESG in the DM (1.6% vs. 1.3%, P = 0.74) compared to the non-DM cohort. The DM cohort had more patients with 30-day readmissions (3.2% vs. 1.9%, P = 0.08) than the non-DM cohort. %TBWL was similar in patients with HbA1c < 9% compared to ≥ 9%, (4.3% each, P = 0.33) with comparable AEs.

CONCLUSION

ESG is a safe procedure in DM patients, without an increase in AEs, and it shows similar short-term weight loss compared to non-DM patients.

Crohn's Disease with Fistula: 10 Year Trends and Mortality in the United States

BACKGROUND/AIMS

Crohn's disease (CD) results in significant morbidity, mortality, and healthcare burden. This study evaluated the temporal trends of CD hospitalizations with a fistula over the last decade to understand the outcomes of severe CD.

METHODS

National Inpatient Sample database from 2009 to 2019 was used to identify CD hospitalizations with a fistula. The outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), and mortality.

RESULTS

There was an increase in the total number of fistulizing CD hospitalizations from 5,386 in 2009 to 12,900 in 2019 (p<0.01). The mean age decreased from 44.9±0.6 to 41.8±0.4 years for the study period (p<0.01). Caucasians were the predominant ethnicity, followed by Africans, Hispanics, and others (p<0.001). The mean LOS for fistulizing CD hospitalizations decreased significantly from 11.57±0.09 days in 2009 to 7.20±0.05 days in 2019 (p<0.001). There was a significant decrease in inpatient mortality from 1.72% in 2009 to 0.73% in 2019 (p<0.01). The MIC did not have a significant trend. There was a decreasing trend toward partial/total colectomies, rectosigmoid, and small bowel surgeries from 2009 to 2019 (p<0.001).

CONCLUSIONS

There has been a rise in CD hospitalizations with fistulizing disease in the last decade. Despite this, the mortality and inpatient LOS have been decreasing significantly. In addition, the increase in CD hospitalizations with fistulizing disease has had no significant effect on hospital costs.

Ten-year trends and prediction model of 30-day inpatient mortality for alcoholic hepatitis in the United States

Background

Alcoholic hepatitis (AH) results in significant morbidity, mortality and healthcare burden. We aimed to evaluate the temporal trends of AH hospitalizations in the last decade and to devise a mortality scoring system for risk stratification.

Methods

National Inpatient Sample (NIS) databases from 2009-2019 were used to identify AH hospitalizations. Outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), mortality, and mortality predictors. A mortality scoring system was derived using multivariate Cox regression and validated using receiver operating characteristic curves.

Results

There was an increase in total AH hospitalizations, from 67,070 in 2009 to 125,540 in 2019 (P=0.004). The inpatient mortality increased from 2.48% in 2009 to 3.78% in 2019 (P=0.008). The MIC was $31,189 in 2009 and $62,229 in 2019 (P<0.001). A trend for LOS was not significant. Ten variables were selected for incorporation into a risk score, including anemia, age >60 years, female sex, mechanical ventilation, vasopressor use, spontaneous bacterial peritonitis, hepatorenal syndrome, acute renal failure, coagulopathy (thrombocytopenia), and hepatic encephalopathy. The score has a maximum of eight points, and the cutoff for predicting mortality was set as 4 points. The area under the curve (AUC) of the derivation cohort was 0.8766 (95% confidence interval [CI] 0.865-0.888) and AUC 0.862 (95%CI 0.855-0.868) for a 30-day period.

Conclusions

There has been an increase in AH hospitalizations and mortality in the last decade. The Tahira score provides an easy objective method to estimate inpatient 30-day mortality for AH hospitalizations.