Laparoscopic sleeve gastrectomy versus endoscopic sleeve gastroplasty: a systematic review and meta-analysis

Abstract

Background and study aims Laparoscopic sleeve gastrectomy (LSG) is the current standard for bariatric surgery, but it is affected by several postoperative complications. Endoscopic sleeve gastroplasty (ESG) was created as a less invasive alternative to LSG. However, its efficacy and safety compared with LSG is unclear. Materials and methods Relevant publications were identified in MEDLINE/Cochrane/EMBASE/OVID/ PROSPERO and NIH up to January 2020. Studies were selected that included obese patients with a baseline body mass index (BMI) between 30 and 40 kg/m² with a minimum of 12 months of follow-up and with reported incidence of complications. The mean difference in percentage of excess weight loss (%EWL) at 12 months between LSG and ESG represented the primary endpoint. We also assessed the difference in pooled rate of adverse events. The quality of the studies and heterogeneity among them was analyzed. Results Sixteen studies were selected for a total of 2188 patients (LSG: 1429; ESG: 759) with a mean BMI 34.34 and 34.72 kg/m² for LSG and ESG, respectively. Mean %EWL was 80.32 % (± 12.20; 95 % CI; P = 0.001; I² = 98.88) and 62.20 % (± 4.38; 95 % CI; P = 0.005; I² = 65.52) for the LSG and ESG groups, respectively, corresponding to an absolute difference of 18.12 % (± 0.89; 95 % CI, P = 0.0001). The difference in terms of mean rate of adverse events was 0.19 % (± 0.37; 95 %CI; χ 2 = 1.602; P = 0.2056). Conclusions Our analysis showed a moderate superiority of LSG versus ESG. No difference in terms of safety was shown between the two groups. ESG is a less-invasive, repeatable and reversable and acceptable option for mild-moderate obese patients.

Bariatric Surgery in Adolescents: To Do or Not to Do?

“…LSG is considered the most commonly performed bariatric surgery worldwide. The safety of the LSG technique, together with high survival rates have been widely demonstrated and LSG has become the surgery procedure of first choice in patients with severe obesity worldwide both in adulthood and pediatric age [ 79 , 87 , 88 , 89 , 90 , 91 , 92 ], and in the adolescent population, LSG appears to have a higher safety profile than other bariatric operations [ 93 ]. The effectiveness of a single procedure in weight loss has been demonstrated in pediatric age [ 88 ].…”

“…This technique is also referred to as “greater curvature gastrectomy”, or “vertical gastrectomy” or “pylorus preserving gastric tube”. The vertical resection involves the greater curvature and the fundus and leads to a gastric tuberization [ 88 ] Gastric resection includes approximately 80% of the stomach and the remnant gastric area has a capacity > 100 mL. Gastric reduction does not require a gastrointestinal anastomosis or bypass which makes it easier than RYGB or BPDDS [ 94 , 95 ].…”

Endoscopic Procedures for Weight Loss

“…Finally, Marincola et al compared those modalities through a meta-analysis design and confirmed that the surgical approach is superior in weight loss. However, no head-to-head study was included as few cohorts, and no controlled studies comparing those two modalities were available [ 59 ]. Moreover, another meta-analysis demonstrated identical results, but the limitations persist as they are related to the literature itself and not to the methodology of the study [ 60 ].…”

Intensifying Treatment: Bariatric Surgery

“…(Figure 5) This new procedure is called an endoscopic sleeve gastroplasty (ESG) or "endo-sleeve". 12,13…”