P3718 - Predictors of Post-Procedural Pain Following Endobariatric Therapy: Experience from Two Academic Centers

Sagar Shah, MD¹, Philip Kozan, MD¹, Qais Dawod, MD², Firas Bahdi, MD³, Julia L. Boland, MD¹, Enad Dawod, MD², Erik Dutson, MD¹, V. Raman Muthusamy, MD, MAS¹, Reem Sharaiha, MD⁴, Danny Issa, MD^1
1UCLA, Los Angeles, CA; ²Weill Cornell, New York, NY; ³David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; ⁴New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY

Introduction: Endoscopic bariatric therapy (EBT) has emerged as a minimally-invasive approach for weight loss in patients with and without a history of bariatric surgery. Pain is a common post-procedural complaint that may necessitate hospital admission, analgesia, and narcotics use, leading to increased cost and morbidity. Given the paucity of data in this area, we aimed to identify factors associated with increased post-procedural pain in a cohort of patients followed closely after EBT.

Methods: This prospective study at two tertiary-care centers in the US evaluated adult patients undergoing primary endoscopic gastroplasty (ESG) and endoscopic revision from 4/2021 to 4/2023. Argon plasma coagulation (APC) was used following suturing in selected cases per endoscopists' discretion to induce scarring and improve durability. The primary outcome was the severity of post-procedural pain measured on a scale from 0 to 10. Mild pain was defined as pain levels 1-4, moderate as 5-7, and severe as 8-10. A z-test of proportions was used to compare proportions and a Student's t-test was used to compare continuous outcome variables.

Results: Sixty-one patients underwent EBT for morbid obesity and were followed longitudinally to monitor post-procedural symptoms and treatment efficacy. Post-procedural pain was reported in 46/61 (75.4%) patients. The average severity of post-procedural pain was 3.1/10 ± 2.5. Twenty-two (36.1%) patients had mild pain, 7(11.5%) had moderate pain, and 17(27.9%) had severe pain (Table 1). 21/61 (34.4%) patients received opiates on discharge; the average duration of use was 7.3 ± 4.1 days. The use of concomitant APC was associated with greater severity of post-procedural pain (3.1 vs. 4.6, P=0.03). A history of irritable bowel syndrome (IBS) or visceral hypersensitivity was associated with worse pain level (2.9 vs. 5.8, p=0.04) in the ESG subgroup (Figure 1). Patients with no-to-mild pain had a lower number of bites-per-suture on average compared to patients with severe post-procedural pain (6.5 vs. 7.1, P< 0.01). A greater proportion of patients underwent primary ESG in the severe pain group (88.2% vs. 52.2%, P< 0.01).

Discussion: We identified the combination of suturing plus APC, number of bites-per-suture, and history of visceral hypersensitivity as risk factors for severe post-procedural pain following EBT. While pain was mild-to-moderate in most patients, identifying patients at risk for severe post-procedural pain is critical to facilitate recovery and prevent unplanned admission.



Disclosures:


Sagar Shah, MD¹, Philip Kozan, MD¹, Qais Dawod, MD², Firas Bahdi, MD³, Julia L. Boland, MD¹, Enad Dawod, MD², Erik Dutson, MD¹, V. Raman Muthusamy, MD, MAS¹, Reem Sharaiha, MD⁴, Danny Issa, MD¹. P3718 - Predictors of Post-Procedural Pain Following Endobariatric Therapy: Experience from Two Academic Centers, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.