Long-term outcomes after endoscopic sleeve gastroplasty: impact of clinician follow-up and lifestyle engagement

Background Bariatric interventions rely on lifestyle changes that benefit from long-term follow-up and patient engagement. Mid- and long-term outcomes following endoscopic sleeve gastroplasty (ESG) are heterogeneous and likely multifactorial. While the literature has explored patient demographic and anthropometric influence, as well as procedural technique, on post-ESG weight loss, there are knowledge gaps about the influence of aftercare programs. We hypothesize that clinician follow-up intensity and exercise participation correlate with weight loss after ESG. Methods We conducted a retrospective cohort study of adults who underwent ESG at a tertiary academic center with expertise in bariatric endoscopy. Patients with at least two years of follow-up and complete weight and behavioral data were included. Follow-up intensity was defined by the number of post-ESG physician or advanced practice clinician visits and categorized as close (≥ 5 visits) or limited (< 5 visits). The primary outcome was total body weight loss (TBWL%) at the most recent follow-up visit; the secondary outcome was the association between exercise participation and TBWL%. Results A total of 56 individuals met inclusion criteria (mean age 49.6 years, 82.2% female). The mean duration of follow-up was 29.0 months. Baseline demographic and clinical characteristics were similar between groups. Patients with close clinician follow-up achieved significantly greater TBWL compared with those with limited follow-up (− 13.7 ± 11.2% vs. − 6.7 ± 8.2%, p = 0.01). In categorical analyses, a higher proportion of the close follow-up group achieved ≥ 10, ≥ 15, and ≥ 20% TBWL. Exercise participation was reported by 69.7% of participants and was associated with numerically higher but nonsignificant TBWL ( p = 0.55). Conclusions Heightened clinician follow-up after ESG was associated with approximately twice the magnitude of long-term weight loss. These findings emphasize that structured, ongoing engagement from clinical team members, as opposed to solely nutritional team members, is a critical determinant of durable success after ESG.