1140 Endoscopic Sleeve Gastroplasty versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis

Abstract

INTRODUCTION: Bariatric surgery remains the most effective and durable treatment for obesity; yet, less than 2% of eligible candidates undergo surgery. Endoscopic sleeve gastroplasty (ESG) is a restrictive procedure that simulates the anatomical changes associated with laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric procedure. We performed a meta-analysis to compare clinical outcomes between ESG and LSG. METHODS: Comprehensive search of multiple databases (PubMed, EMBASE, Cochrane, Web of Science) since the inception of ESG (2013) to April 2019. Studies were included if they reported data needed for calculation of post-intervention percentage total body weight loss (%TBWL) and adverse events. Pooling was conducted by using either fixed or random-effects model depending on heterogeneity across studies. RESULTS: A total of 5822 studies were initially identified, of which 18 studies (1446 ESG and 2071 LSG patients) were included. The pooled mean %TBWL at 6 months was lower in the ESG group (14.3; 95% CI: 12.8-15.9) when compared to LSG (25.5; 95% CI:23.9-27.2) (P < 0.001). Similarly, the estimated mean %TBWL at 12 months was lower for ESG (15.7; 95% CI:13.5-17.9) versus LSG (29.5; 95% CI:27.3-31.7) (P < 0.001). The pooled rate for adverse events was significantly higher in patients who underwent LSG (7.8%; 95% CI: 4.3-12.1) compared to ESG (1.9%; 95% CI: 0.7-3.7) (P < 0.001). CONCLUSION: ESG achieves less weight loss at 6 and 12 months when compared to LSG, but LSG is associated with more adverse events. ESG is an acceptable minimally invasive approach for non-surgical candidates or for those seeking alternatives besides conventional bariatric surgery.