Endoscopic gastric plication: a network meta-analysis

Abstract

Background: Bariatric surgery is associated with sustainable weight loss and lower mortality. Presently, these procedures can be performed endoscopically. Among endoscopic procedures, endoscopic gastric plication (EGP) is the most studied but has not yet been compared among its variations. Method: Studies were identified by searching database and reference lists. They would be eligible if they were conducted in adult patients with obesity, did not involve revision, compared EGP and controls, and reported at least 1-year weight loss results. The interventions of interest were endoscopic sleeve gastroplasty (ESG), primary obesity surgery endoluminal (POSE), and transoral gastroplasty (TOGA). The primary outcome was the percentage of excess weight loss (%EWL). From network meta-analysis, treatment comparisons between each intervention were estimated. The interventions were further ranked in terms of maximizing weight loss or minimizing severe adverse events (SAEs). Results: Significant %EWLs from ESG and POSE versus control were observed at 12 months with pooled mean differences (MDs) and 95% CI of 44.7% (27.95%, 61.45%) and 16.29% (0.32%, 32.26%), respectively. The results also indicated that ESG was more efficacious than POSE [MD (95% CI): 28.41% (5.27%, 51.56%)] and TOGA [MD (95% CI): 36% (11.38%, 60.62%)]. For SAEs, ESG, POSE, and TOGA yielded relative risks (95% CI) of 2.81 (0.14, 56.85), 2.15 (0.13, 36.48), and 3.26 (0.07, 153.3), respectively, compared with the control. Conclusions: ESG was the best EGP, followed by POSE and TOGA. No significant increase in SAE was indicated from EGP. This network meta-analysis must be updated when more data are available.