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SAGES 2026 Annual Meeting Emerging Technology Session
March 25-28, 2026 | Tampa, FL, USA
P262
Comparative Analysis of Diabetes Mellitus Remission After Endoscopic vs Laparoscopic Sleeve Gastrectomy Using Fragility Index
Poster Presenter
Part of Topic
Bariatric
Introduction
Endoscopic sleeve gastroplasty (ESG) has emerged as an incisionless alternative to laparoscopic sleeve gastrectomy (LSG) for patients with obesity who are either not surgical candidates or decline surgery. ESG reliably achieves weight loss and meets the minimum efficacy threshold defined by ASGE and ASMBS, but questions remain regarding the durability of ESG and its effect on metabolic outcomes compared with LSG. Diabetes remission is one of the most clinically relevant endpoints, yet published data are limited, heterogeneous, and rarely subjected to measures of statistical robustness.
Methods
We performed a structured PubMed search using the terms “endoscopic sleeve gastrectomy,” “laparoscopic sleeve gastrectomy,” and “diabetes.” All comparative studies, cohorts, and randomized controlled trials reporting type 2 diabetes (T2DM) outcomes in both ESG and LSG arms with extractable event counts were screened. Two reviewers independently abstracted study design, baseline characteristics, follow-up duration, and absolute remission counts; disagreements were resolved by consensus. The primary outcome was T2DM remission or resolution as defined by the individual study protocol, most commonly medication cessation with normalization of HbA1c and fasting glucose. For studies reporting a statistically significant difference, we calculated the fragility index (FI), defined as the minimum number of outcome reversals needed to convert the p value from <:0.05 to >:0.05 using a Fisher’s exact test.
Results
Nine studies were identified, of which two met inclusion criteria. Alqahtani et al. reported the largest matched cohort to date (3018 ESG–LSG pairs). Diabetes remission occurred in 64% of ESG and 82% of LSG patients (p = 0.00022) with an FI of 10, indicating that the result is statistically robust. Joseph et al. reported a smaller, unmatched single-center series (n = 280), in which remission occurred in 44 % of ESG and 50 % of LSG patients (p = 1.00), yielding an FI of 0 and no statistically significant difference.
Conclusion
Our findings suggest that LSG is associated with higher diabetes remission rates than ESG in the largest propensity-matched cohort studied to date, and that this result is reasonably robust to outcome misclassification. However, the evidence remains limited to single-center observational data, and residual confounding cannot be excluded. These results should be interpreted as hypothesis-generating and underscore the need for multicenter prospective studies with standardized biochemical definitions and longer metabolic follow-up.