Comparing long-term weight loss and complications in endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy: a systematic review and meta-analysis.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric operation worldwide, with the endoscopic sleeve gastroplasty (ESG) emerging as a non-surgical bariatric procedure with comparable outcomes to LSG. Long-term comparative data of ESG to LSG are limited but increasing. The purpose of this study was to compare the long-term efficacy and adverse outcomes including rates of de novo gastro-esophageal reflux disease (GERD). METHODS: A systematic review and meta-analysis were performed comparing outcomes of ESG versus LSG using a random effects model with restricted maximum likelihood. A comprehensive search of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and Cochrane Library (via Wiley) was performed. Studies comparing outcomes and adverse events following primary ESG or LSG with a sample size > 5 were included. RESULTS: Of 1136 unique results, 10 studies were included, comprising 7442 patients, of whom 3583 (48%) underwent ESG and 3859 (52%) underwent LSG. Mean age was 35.5 years and mean initial BMI was 34.6 kg/m2. Most patients were female (86.2%) and mean follow-up was 32.1 months. Meta-analysis revealed ESG was associated with lower total body weight loss (TBWL%) at 6 months (9 studies, mean diff. -8.34%, 95%CI, -10.50 to -6.19), 12 months (6 studies, mean diff. - 12.58%, 95%CI -15.47 to - 9.70) and 24 months (3 studies, mean diff. -9.81%, 95%CI -14.72 to -4.90). ESG was associated with a lower risk of both overall adverse events (9 studies, RR 0.54, p = 0.03) and de novo (GERD) (5 studies, RR 0.33, p = 0.02). CONCLUSIONS: The results of this review suggest that while LSG achieves greater weight loss up to two years postoperatively, ESG still displays moderate weight loss with a significantly lower risk of both adverse events and de novo GERD, making it a potential option for patients wishing to avoid greater surgical risks or with pre-existing GERD.