INTRODUCTION & OBJECTIVES
•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.1
•Long-term comparative data of ESG to LSG is limited1,2
•Objective: compare the long-term efficacy and adverse outcomes including rates of de novo gastro-esophageal reflux disease (GERD) of ESG to LSG.
METHODS
•Systematic review and meta-analysis according to PRISMA guidelines
•Comprehensive search of 5 databases
•Studies comparing outcomes and/or adverse events following primary ESG or LSG with a sample size >5 were included
•Meta-analysis using random effects model with restricted maximum likelihood performed to compare %TBWL at 6, 12, and 24 months, adverse events and incidence of de-novo GERD in ESG vs LSG
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.
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=0.020).
CONCLUSIONS
•LSG provides greater weight loss compared with ESG up to 24 months of follow-up, but at the expense of higher adverse event rates and greater risk of de-novo GERD.
•ESG may be an attractive option for patientsseeking a less invasive intervention with moderate weight loss and a faster recovery.
•LSG may be better suited for selected patients without significant GERD who prioritize maximal weight reduction.
•Further long-term, prospective and comparative and studies are needed.
REFERENCES
1.Yoon JY, Arau RT. The efficacy and safety of endoscopic sleeve gastroplasty as an alternative to laparoscopic sleeve gastrectomy. Vol. 54, Clinical Endoscopy. Korean Society of Gastrointestinal Endoscopy; 2021. p. 17–24.
2.Beran A, Matar R, Jaruvongvanich V, Rapaka BB, Alalwan A, Portela R, et al. Comparative Effectiveness and Safety Between Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: a Meta-analysis of 6775 Individuals with Obesity. Obes Surg. 2022 Nov 1;32(11):3504–12.
CONTACT INFORMATION
Brianna Brand – babrand@ualberta.ca
