Outcomes of endoscopic sleeve gastroplasty; how does it compare to laparoscopic sleeve gastrectomy? A systematic review and meta-analysis

Abstract

Background and study aims Endoscopic sleeve gastroplasty (ESG) is a novel moderately invasive technique in endo-bariatrics as compared to laparoscopic sleeve gastrectomy (LSG). Data is limited as to its efficacy and safety. Methods We searched multiple databases from inception through August 2019 to identify studies that reported on ESG in the treatment of obesity. Our goals were to calculate the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1 month, 6 months, and 12 months with ESG. We included studies that reported on LSG, in a similar time frame as ESG, and compared the 12-month outcomes. Results From eight studies on ESG (1815 patients), the pooled rates of %TWL at 1 month, 6 months, and 12 months were 8.7 (7.2–10.2), 15.3 (14.1–16.6) and 17.1 (15.1–19.1), respectively. The pooled rates of %EWL at 1 month, 6 months, and 12 months were 31.7 (29.3–34.1), 59.4 (57–61.8) and 63 (51.3–74.6), respectively. The pooled rates of BMI at 1 m, 6 m, and 12 m were 32.6 (31–34.3), 30.4 (29–31.8) and 30 (27.7–32.3, I2 = 97), respectively. At 12 months, the pooled %TWL, %EWL and BMI with LSG (7 studies, 2179 patients) were 30.5 (27.4–33.5), 69.3 (60.1–78.4) and 29.3 (27.1–31.4) respectively. On comparison analysis, %TWL with LSG was superior to ESG (P = 0.001). %EWL and BMI were comparable. All adverse events, bleeding and gastro-esophageal reflux disease were significantly lower with ESG when compared to LSG. Conclusion ESG demonstrates acceptable weight loss parameters and seems to have a better safety profile when compared to LSG.

Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?

“…In contrast, the risk of adverse events with ESG in our study was low, in keeping with the published literature [39]. Similarly, the rate of new-onset GERD after ESG was negligible, as the fundus of the stomach is left intact, and the neuronal innervation of the stomach is maintained [24,39]. These findings, along with its better weight loss results, may make ESG a patient-preferred treatment option.…”

“…There are several reasons for its increasing acceptance, including its technical ease, short procedure time, low complication rate, and its resemblance to LSG or LGCP. Multiple studies have demonstrated its short-and medium-term efficacy [24]; however, long-term studies assessing its effectiveness are lacking. A study published only in abstract form showed that ESG achieved a %TBWL of 14.5 % at 5 years [25].…”

The Efficacy and Safety of Endoscopic Sleeve Gastroplasty as an Alternative to Laparoscopic Sleeve Gastrectomy

“…Three observational studies [ 17 - 19 ] and two meta-analyses [ 20 , 21 ] directly compared the effectiveness of ESG and LSG. An unmatched cohort study by Novikov et al in 2018 reported that the %TBWL with LSG was significantly superior at 12 months than that with ESG (29.3% vs. 17.6%, p <0.001) [ 17 ].…”

“…A meta-analysis of two studies directly comparing LSG and ESG showed significant differences in the mean %TBWL (8.52; 95% CI, 6.35–10.69; p <0.00001) at 6 months, favoring LSG over ESG [ 17 , 18 , 20 ]. In another meta-analysis of eight studies with 1,815 ESG patients and seven studies with 2,179 LSG patients, the pooled rates of %TBWL with LSG were statistically superior at 12 months to the rates with ESG (30.5% vs. 17.1%, p =0.001) [ 21 ]. Current evidence indicates that ESG offers satisfactory efficacy in patients with mild-to moderate and inferior efficacy to LSG in those with severe obesity; it is better than other endoscopic procedures like intra-gastric balloon [ 22 ].…”

Primary obesity surgery endoluminal (POSE-2) procedure for treatment of obesity in clinical practice

“…Endoscopic gastroplasty (EG) may represent a suitable alternative. It induces significant weight loss, reverses comorbidities, has a low complication rate, and requires only a short hospital stay [2,3,4].…”